Operative Dentistry (Restorative)

A 26-year-old with high caries risk presents with multiple incipient, non-cavitated proximal lesions (E1–E2 on bitewings) and good motivation.

A 35-year-old with a stained occlusal fissure on a mandibular first molar shows no softness on probing; DIAGNOdent is low; bitewing shows no radiolucency.

A 42-year-old has a small cavitated Class V carious lesion with poor moisture control near the gingival margin.

A 28-year-old reports cold sensitivity after a deep Class I composite placed yesterday; occlusion is slightly high.

A deep occlusal caries approaches the pulp with soft dentin at the base in an asymptomatic vital tooth.

A 33-year-old with xerostomia from Sjögren’s has widespread cervical caries.

During a Class II composite, proximal contact is open despite proper contouring.

For a hypersensitive non-carious cervical lesion (NCCL) without cavitation, patient prefers noninvasive care.

A 45-year-old has a cracked cusp on a heavily restored mandibular molar with cusp flexure pain on biting; tooth is vital.

After etching and bonding a Class I composite, the field is contaminated by saliva before curing.

A 30-year-old has interproximal radiolucency at the outer third of dentin (D1–D2) on bitewing with contact-limited access.

A 27-year-old presents with post-op sensitivity after a large Class II composite; layering was done in one 4–5 mm bulk increment using conventional composite.

A 39-year-old wants bleaching; multiple anterior composites are present.

A small mechanical pulp exposure occurred during caries removal in a healthy young tooth with no symptoms.

A high-caries-risk patient with poor flossing has recurrent Class II composite failures at gingival margins.

A 52-year-old bruxer fractures multiple posterior composites over 2 years.

For a deep proximal box with subgingival margin on dentin, moisture control is challenging.

A 24-year-old with white spot lesions after orthodontics asks for “drill-free” options.

A 40-year-old presents with NCCL at the CEJ on a canine with heavy occlusal load and toothbrush abrasion.

During a Class II composite, a gingival overhang is noted on bitewing at review.

A patient with high caries risk asks about silver diamine fluoride (SDF).

A 36-year-old needs a posterior restoration; interproximal area is hard to isolate due to saliva contamination.

A 29-year-old has a small Class IV fracture of the maxillary central incisor; patient desires best polish and translucency.

A 60-year-old with root caries on exposed cementum near the CEJ, high caries risk, and limited dexterity.

A composite placed with a strong self-etch adhesive on aprismatic enamel shows marginal staining after 6 months.

A deep Class II box shows pink hue after dentin removal; no frank bleeding. Tooth is asymptomatic.

A 47-year-old requests replacement of an amalgam with composite for esthetics; margins are intact, no secondary caries.

A 32-year-old with eroded palatal surfaces from GERD seeks restoration of anteriors.

A 21-year-old has an occlusal pit-and-fissure lesion with limited undermined dentin under enamel cap.

After finishing a Class V composite, a white line appears at the enamel margin.

A 55-year-old with abrasion/erosion notched lesions on premolars complains of cold sensitivity; lesions are shallow and non-carious.

During a posterior composite, a C-factor–heavy cavity (Class I) is restored. How to reduce shrinkage stress?

A 38-year-old with fluorosis wants minimally invasive esthetic improvement of opaque white/brown spots.

A proximal caries lesion extends just below the contact; rubber dam is placed but moisture persists cervically.

A large MOD composite repeatedly fractures; cusps are undermined.

A 44-year-old with proximal dentin lesion and heavy plaque wants to delay drilling if possible.

A 51-year-old has marginal staining on a 2-year-old composite with intact margins and no secondary caries.

A patient with sclerotic dentin in a cervical lesion shows poor bonding with total-etch.

A 36-year-old presents with a localized cavitated proximal lesion in a primary molar in an otherwise cooperative adult with mixed dentition (special needs caregiver).

A 48-year-old with a deep Class II lesion exhibits bleeding dentin and frank pulp exposure after complete excavation. Tooth was asymptomatic pre-op.

A 26-year-old with moderate fluorosis wants conservative improvement of white/brown mottling on incisors.

A 39-year-old reports sensitivity after a large Class II composite; bite shows fremitus and heavy excursive contacts over the restoration.

During matrix placement for a wide MOD lesion, the proximal contour remains flat with open contact.

A deep carious lesion on a vital molar has affected dentin at the pulpal floor but firm dentin peripherally.

After home bleaching (16% carbamide peroxide), a patient needs bonded composite the next day.

During rubber dam placement for a Class II, subgingival bleeding compromises isolation.

A 31-year-old with NCCL wants durable esthetics at a canine with heavy occlusal load.

A composite placed over eugenol-containing temporary exhibits marginal breakdown at 3 months.

For a fractured cusp on a heavily restored molar, remaining walls are 1.5 mm thick.

A deep margin extends 1 mm below the gingival margin on dentin.

A posterior composite shows recurrent caries at the gingival margin only; rest is sound.

After finishing, the proximal surface is rough and plaque-retentive.

A patient with high caries risk asks for “strongest filling” in Class II.

During adhesive placement, dentin was over-dried (“frosty”); bond strength is compromised.

A 28-year-old with bruxism requests conservative posterior esthetic restorations.

A small enamel-only proximal lesion is detected on bitewing in a low-risk patient.

After rubber dam removal, a positive “rocking” contact is noted causing food impaction.

A deep Class V on root surface bleeds easily despite isolation attempts.

A 43-year-old with hypersensitivity post-bleaching wants immediate cervical restorations.

A cusp-protecting onlay debonds after 6 months; notes show contaminated field and incomplete isolation.

A 50-year-old with moderate NCCLs and high acidic beverage intake seeks restorations.

After bonding, marginal gap is visible at the gingival floor of a Class II.

A 29-year-old with white spot lesions prefers non-invasive esthetic management before a wedding in 2 weeks.

A previously restored MOD shows fracture of the marginal ridge only; rest of restoration is sound.

A patient complains of “plastic taste” after new composite; clinician suspects incomplete cure.

A wide proximal box shows dark dentin at DEJ that is hard and shiny on probing.

After isolation with a metal clamp, enamel cracks are noted near the cervical area.

A 36-year-old with composite veneers desires re-polishing for surface roughness and staining.

A pinhole exposure occurred while adjusting occlusion on a deep Class I composite placed today; tooth is asymptomatic.

A patient with severe gag reflex cannot tolerate standard rubber dam placement.

A deep proximal lesion in a molar requires shade matching.

In a high C-factor Class I, which technique best reduces shrinkage stress?

A 34-year-old with erosive wear on palatal surfaces needs additive rehabilitation.

A 40-year-old complains of floss catching at a new Class II composite.

After bleaching, white spot lesions look more obvious.

A composite repair is planned on an old restoration.

A 29-year-old with interproximal caries and tight contacts makes matrix placement difficult.

The patient reports sensitivity to sweets and cold at a recent deep restoration; percussion negative, lingering cold negative.

After finishing, a gray shadow is seen under proximal enamel of an anterior composite.

A patient with minimal caries risk asks about replacing small stained but sound fissures for “cosmetics.”

A 25-year-old with moderate caries risk presents with a non-cavitated proximal E2 lesion on bitewing and excellent compliance.

A 31-year-old with a deep occlusal lesion is asymptomatic; after selective caries removal, the pulpal floor is leathery.

A 45-year-old complains of sharp pain on biting on a heavily restored mandibular molar; cold is brief; cracks visible.

During a Class II composite, persistent moisture is present from crevicular fluid at a subgingival margin.

A 36-year-old bruxer needs posterior restoration; high occlusal load is expected.

After home bleaching, the patient needs a bonded veneer next day.

A 28-year-old has a small Class V NCCL with hypersensitivity and high salivary flow.

During matrix placement for a wide MOD, contact remains open despite Tofflemire use.

A 40-year-old presents with stained fissures, sound to explorer, no radiolucency; caries risk is high.

A deep proximal composite shows a white line at enamel margin after finishing.

A 52-year-old has recurrent caries only at the gingival margin of an otherwise sound Class II composite.

A deep Class I cavity on sclerotic dentin shows poor bonding with total-etch.

After placing a large MOD composite in one 5 mm increment, patient returns with sensitivity.

A 60-year-old with limited dexterity has root caries lesions near the CEJ.

A posterior composite shows a gingival overhang on bitewing at 6-month review.

A 33-year-old with erosive wear from GERD seeks anterior restoration.

A 27-year-old needs repair of an old composite.

A 41-year-old has post-op cold sensitivity after a deep Class II; occlusion is slightly high.

A 35-year-old presents with a subgingival proximal margin 1.5 mm below the CEJ; isolation is poor.

A patient requests replacement of intact amalgam for esthetics.

During adhesive steps, dentin is over-dried and appears frosty.

A 47-year-old complains of floss catching on a recent Class II composite.

A palatal composite veneer shows gray show-through; tooth is vital.

A 29-year-old with white spot lesions post-orthodontics seeks rapid esthetic improvement.

A proximal dentin caries is diagnosed in a low-risk patient who prefers to delay.

After finishing, occlusal contacts show heavy interferences on a new onlay.

A deep Class II shows pink pulpal hue without bleeding after caries removal; patient is asymptomatic.

A 58-year-old with xerostomia from medications develops recurrent cervical lesions.

A posterior composite debonds; notes show contamination during bonding.

A 50-year-old with high acidic intake presents with multiple NCCLs; wants long-term solution.

After etching, saliva contaminates the enamel before bonding.

A 38-year-old with tight posterior contacts makes matrix placement difficult.

A patient reports a “chemical taste” after a temporary eugenol dressing under a planned composite.

A 42-year-old with moderate fluorosis wants minimal prep esthetics.

A deep proximal lesion requires shade matching under operatory lights.

A large MOD restorable tooth repeatedly fractures with direct composites.

A patient with white spot lesions immediately after bleaching notes worse appearance.

A 48-year-old with a deep cervical lesion and bleeding sulcus despite dam isolation.

A repaired composite shows dull finish and plaque accumulation.

After a Class II restoration, the contact is tight but food impaction persists; embrasure form looks flat.

A 33-year-old with deep occlusal caries is asymptomatic; after selective removal the pulpal floor remains soft but there is firm dentin peripherally.

A 27-year-old reports cold sensitivity one week after a large Class II composite; percussion is normal, no lingering pain. Occlusion shows a high contact.

During a Class II restoration, saliva contaminates the etched enamel before adhesive application.

A 45-year-old with xerostomia from medications develops recurrent cervical caries.

A fractured MOD composite on a bruxing patient recurs despite proper technique.

After home bleaching, a patient needs a bonded composite veneer tomorrow.

A small enamel-only proximal lesion (E2) is found in a low-risk patient.

During adhesive steps, dentin is overdried and appears “frosty.”

A deep proximal box extends subgingivally on dentin and isolation is difficult.

A 29-year-old has white spot lesions after orthodontics and seeks a drill-free cosmetic option.

During matrix placement, the contact remains open despite a Tofflemire band.

A 41-year-old with stained fissures that are sound to explorer and caries-susceptible.

A large Class II was placed in one 5 mm increment of conventional composite; patient returns with sensitivity.

A deep Class V on root surface bleeds easily; moisture persists.

A 37-year-old complains floss catches on a new Class II composite; bitewing shows a gingival overhang.

Shade selection was performed after 25 minutes under rubber dam; final restoration looks too light.

A repaired composite shows dull surface and plaque accumulation.

A 48-year-old with erosive palatal wear requests additive rehabilitation.

A Class II composite exhibits a white line at the enamel margin after finishing.

A patient with minimal caries risk wants “cosmetic replacement” of stained but sound fissures.

During adhesive steps for a deep restoration, hemostatic gel (ferric sulfate) contacts the bonding surface.

A high C-factor Class I is planned; how to reduce polymerization stress?

A 52-year-old with root caries and limited dexterity asks for the most durable option.

After finishing a proximal surface, floss shreds and catches despite a tight contact.

A previously placed composite veneer shows gray show-through at the incisal third.

A 34-year-old with multiple NCCLs from abrasion/erosion is pain-free but wants prevention.

A wide proximal box requires reliable contact and contour in a deep restoration.

A new onlay shows high excursive contacts causing pain on chewing.

A repaired proximal margin still looks rough and plaque-retentive.

A patient insists on replacing an intact, asymptomatic amalgam solely for esthetics.