PAPER 1

You are fitting a lingual fixed appliance for a 30-year -old fema le; you will be using this accessory as part of the process.
Wlhat is the most important benefit of using tihis accessory?

Isolation and moisture control

Ensuring precision of bracket placement

Retraction of the tongue to allow improved visua lisation of the lingualsurfaces of the teeth

Safe transfer of the brackets reducing risk of swallowing or inhalation of brackets

Reduced chairside time

A 22-year-old female patient is referred to you who complains that her "face is all over the place". She tells you that
she does not like going out because she feels that people stare at her "wonky face" all the time. She saw your
colleague a year ago who had advised against any treatment. On examination you find her to have a very mild
mandibular asymmetry for which you consider the risks of treatment outweigh the benefits. Which of the following
best explains this patient's complaints?

Bulimia nervosa

Bi-polar disorder

Chronic depression

Body dysmorphic disorder

Obsessive compulsive disorder

Alginate consists of various ingredients which regulates its properties to make it a suitable material to make impressions which are accurate to orthodontic
appliances. Which ingredient contributes to the extended working time?

Ammonium salts

Diatomaceous earth

Potassium alginate

Potassium sulphate

Sodium phosphate
A 13-year-old girl is being treated with a functional appliance. She has been weari ng this for nine months and you would like to evaluate the treatment
changes that have occurred before planning your next phase of treatment. You have two cephalometric radiographs; one taken before the start of
treatment and the other taken today. Which cephalometric assessment method is the most appropriate for comparison of the two radiographs?

Template Analysis

Pancherz Analysis

Wits Analysis

Harvold Analysis

Functional Occlusa l Plane Analysis

A 14-year old patient has just had the headgear fitted with the appropriate vector of force as indicated in the diagram for the purpose of anchorage
reinforcement. What will be the most appropriate force and duration of wear to achieve this?

125g per side for 12 hours per day

250g per side for 12 hours per day

450g per side for 12 hours per day

250g per side for 16 hours per day

450g per side for 16 hours per day

You fitted an upper removal appliance for an 8-year-old girl three days ago. She returns with numerous vesicles and ulcers on the mucosa of the
gingivae, lips and tongue. These have been present for a day. She is feeling generally unwell and has not eaten properly since the ulcers appeared. On
questioning she has not had ulcers before. As well as advising increased fluid intake and analgesics, what is the most appropriate plan for immediate
management of this patient?

Refer for allergy testing to acrylic

Prescribe antiviral medication e.g. acyclovir

Prescribe a choline salicylate gel e.g. Bonjela

Refer to a gastroenterologist to test for Crohn's disease

Refer to oral medicine for investigation for oral aphthous ulceration

You are part of a research group that wants to carry out a prospective cohort study which will assess soft tissue facial changes in growing patients with a history
of TMJ trauma. What is the most appropriate investigative toolto measure the soft tissue facial changes?

Ultrasound

Bone scintigraphy

Optical surface scanning

Magnetic resonance imaging

Cone beam computerised tomography

A 12 year-old girl attends for assessment. She has an unerupted maxillary canine which you suspect is palatally impacted. You are considering the most
appropriate imaging for this patient. Which of the following options best describes the effective radiation dosage of a standard resolution cone beam CT
of the maxilla compared with an orthopantomogram and an intra-oral view?

The dose is approximately the same

The dose is approximately double

The dose is approximately 3 times greater

The dose is approximately 5 times greater

The dose is approximately 8 times greater

A 9-year-old boy attends to start orthodontic treatment. He has a unilateral posterior crossbite on the right side with a displacement on closure.
Your lab has constructed a quad helix appliance, which you will now fit. What is the most appropriate way to activate this appliance before
cementation?

Expand by V4 molar width on the right side

Expand by V4 molar width bilatera lly

Expand by Y2 molar width on the right side

Expand by Y2 molar width on the left side

Expand by Y2 molar width bilatera lly

A 21-year-old female has requested correction of her malocclusion through removable aligner treatment. You have been sent the following digital
treatment plan by the aligner manufacturer. How is the digital treatment plan proposing that a good buccal segment interdigitation
is achieved?

By carrying out 0.7 mm of interproximal reduction in the upper arch

By carrying out 0.8 mm of interproximal reduction in the upper arch

By carrying out 1.5 mm of interproximal reduction in the upper arch

By leaving 0.8 mm of space in the upper arch

By leaving 1.5 mm of space in the upper arch

A 13-year-old girl is undergoing fixed appliance treatment to camouflage her Class IIdivision 1malocclusion. She has a pre-adjusted edgewise
fixed appliance in place with a 0.022" slot. She is in an upper 0.019x 0.025" SS archwire. You adjusted her fixed appliances yesterday to start
bodily retraction of her upper incisors. This diagram represents her upper central incisor. The dotted brown outline
indicates the direction of tooth movement. What best describes the area shaded brown?

A zone of tension

A zone of compression

A zone of osteoblastic activity

A zone of bone deposition

A zone of root resorption

A 12-year-old patient attends to start orthodontic treatment. You had previously requested that the dentist extract the upper and lower second deciduous
molars to allow eruption of the unerupted second premolars. When you examine the mouth you see that the dentist has removed the first permanent molars in
error. You believe that you can still achieve a good result but it will take a little longer. What is the most appropriate way to manage this situation?

elle Write to the dentist not mentioning that the first molars have been removed and ask for removal of the second primary molars

Say nothing to the patient as the dentist is a good friend and you think that you can achieve a good orthodontic result without
anyone knowing what has happened

Inform the patient and parent that the dentist has removed the wrong teeth but that you believe that you can achieve a good result.
Then contact the dentist

Speak to the dentist and ask them to inform the patient that they extracted the wrong teeth

Say nothing to the patient but inform the dentist. Arrange a review appointment in six months when you hope the second primary
molars will be lost. nform the patient at that appointment
You are considering changing your band cement. Literature provided by the manufacturer shows the survival probability of your existing
·cement to be 0.918 at 12 months and the new cement to be 0.879 using a log rank test. The p value of this difference in survival is 0.045. What does
this tell you about the new band cement?

elle
There is no clinical or statistically significant difference between the two cements

The new band cement has less chance of failure but this is not statistically significant at the 5% level

The new band cement has less chance of failure and this is statistically significant at the 5% level

The new band cement has more chance of failure but this is not statistically significant at the 5% level

The new band cement has more chance of failure and this is statistically significant at the 5% level
A 15-year-old boy attends for assessment. He has a Class IIDivision 1incisor relationship on a Skeletal 2 base and reduced vertical proportions. There
is a fully-erupted supplemental upper right lateral incisor. The overjet is 9 mm and the overbite is increased, complete to the palate and traumatic. There
is a left sided scissors bite affecting the premolars and severe lower arch crowding, with a contact point displacement of 4.5 mm between the lower left
lateral incisor and canine. All permanent teeth,apart from the third molars, have erupted. What is the IOTN dental health component of this patient?

elle
4.a

4.d

4.f

4.1

4.x
This 15-year-old girl attends for assessment. Her dentist is concerned that she has unerupted teeth in the lower right,lower left and upper right quadrants.
You take the following radiograph:

What is the most likely outcome for the unerupted lower molars and premolars in this patient? They are

likely to erupt,given more time, without orthodontic intervention

The lower molars cannot be aligned but all the premolars should erupt following exposure and orthodontic traction

The lower premolars cannot be aligned but the lower molars should erupt following exposure and orthodontic traction

The lower premolars and lower molars should erupt following exposure and orthodontic traction

The premolars and lower molars cannot be aligned

This 9-year-old boy presents complaining of pain on eating due to his anterior crossbite. The lower right central incisor is grade 1mobile. He has a Class
1skeletal pattern,there is a history of molar incisor hypomineralisation and all first permanent molars have previously been extracted. His oral hygiene is
fair, although he has struggled with this in the past. What is the most appropriate plan for the management
of this patient?

No treatment, await spontaneous correction

Plan to correct with fixed appliances when all permanent teeth have erupted
No treatment,await spontaneous correction

Plan to correct with fixed appliances when all permanent teeth have erupted

Treatment now with a removable appliance

Treatment now with a protraction facemask

Treatment now with an upper fixed appliance

A 60-year-old female attends for assessment. She has large multisurface amalgam restorations in all maxillary premolars and molars; these were
completed twenty years ago and have been asymptomatic since then. She requests upper arch alignment using ceramic fixed appliances. As well as
normal risks associated with fixed appliance treatment, what additional iatrogenic consequence is most important to discuss with this patient?

Irreversible pulpitis

Demineralisation

Cuspal fracture

Periapical pathology

Root resorption
You fitted these appliances six months ago:

Your next step is to place an upper 0.019"x0.025" stainless steel archwire. Wlhat is the most appropriate adaptation to make to the archwire for
this patient?

Buccal root torque and constriction

Palatal root torque and expansion

Buccal crown torque and expansion

Palatal crown torque and constriction

Buccal root torque and expansion

You are asked to see this 14-year-old girl for transfer of her orthodontic care. Records provided by her previous orthodontist show that she had a closed
exposure and bonding of gold chain to her buccally positioned upper left permanent canine nine months ago. Her fixed appliances have been in place for
six months. Study models taken at the start of treatment show a well aligned Class Imalocclusion with good buccal segment interdigitation. What is
the most appropriate next step in the management of this patient?

Increase the force placed on the canine using the same piggy back technique but a larger diameter flexible archwire

Use the same flexible archwire but add a rectangular stainless steel base archwire to avoid worsening of the lateral open bite

Continue with the piggy back as above but use inter-arch elastics to avoid worsening of the lateral open bite

Stop orthodontic forces and take a cone beam CT scan to look for reasons for the canine not moving

Request open exposure of the buccally placed canine using an apically repositioned flap
You are planning to place a temporary anchorage device between the lower left first and second premolars to support anchorage. The patient has mitral
valve problems. Following topical anaesthesia with a 5% Udocaine gel what is the most appropriate anaesthetic for this patient?

Intra ligamentous injection with Articaine 4% with 1:80,000 adrenaline

Infiltration with Lidocaine 2% with 1:80,000 adrenaline

Infiltration with Mep'ivocain 3% without adrenaline

ID block with Udocaiine 2% with 1:80,000 adrenaline

ID block with Articaine 4% with 1:200,000 adrenaline

You are designing a Removable Orthodontic appliance where an active component is required to retract a canine that is fully erupted and in the line of the arch.
What component would be the most appropriate to deliver the optimum efficient retraction of the tooth?

Reverse cantilever sp:ring

T spring

Buccal canine retractor

Palatal finger spring

Screw section
A 14-year-old girl attends fo.- a fixed appliance adjustment appointment. Her upper and lower fixed appliances were fitted six months ago and her oral
hygiene has always been good. Today she has gingival inflammation and generalised plaque deposits on the teeth and appliance. Her Mother reports that
the family are going throu:gh a difficult period of time at the moment. What is the most appropriate plan for management of this patient?

Refuse to carry out any treatment and rebook once the oral hygiene has improved

Carry out the fixed appliance adjustment

Carry out the fixed appliance adjustment and reinforce oral hygiene and dietary advice

Take out the archwire until next visit to facilitate oral hygiene measures

Debond tlhe appliance immediately

This 17-year-old patient has been referred to you for assessment. You notice there is a chin-point asymmetry, which corresponds with the dental centre-lines. The
patient mentions that she thinks the asymmetry might be getting worse. What is the most valuable next step in helping you to asses this patient?

Submentovertex view to ascertain the extent of asymmetry elsewhere in the facial bones

Study models and photographs and review in six months to see if burnt out

Cone-beam CT and review in six months to see if burnt out

MRI to image the TMJ soft-tissues, which are likely to be the cause of the progressive asymmetry

Radio-isotope scan of the mandibular condyles and review in a year to see if burnt out
You completed orthodontic treatment for this 15-year-old male eighteen months ago. This picture shows his occlusion at debond.

His parents contact you on a Saturday afternoon and explain that two hours ago he traumatised his teeth playing rugby. This picture was taken on
arrival.

Radiographs show no root fractures. What is the most appropriate next step in management of this patient?

Refer the patient to a Maxillofacial Surgeon for surgical repositioning of the upper left central and lateral incisors

Extract both incisors and provide an immediate partia l denture

Re-bond both upper and lower arches, working up to full size archwires as soon as possible. Stabilise the upper teeth with the fixed
appliance for at least six weeks
His parents contact you on a Saturday afternoon and explain that two hours ago he traumatised his teeth playing rugby. This picture was taken on
arrival.

Radiographs show no root fractures. What is the most appropriate next step in management of this patient?

Refer the patient to a Maxillofacial Surgeon for surgical repositioning of the upper left central and lateral incisors

Extract both incisors and provide an immediate partial denture

Re-bond both upper and lower arches, working up to full size archwires as soon as possible. Stabilise the upper teeth with the fixed
appliance for at least six weeks

Re-bond the upper arch only and use a thin flexible archwire with a view to completing treatment within 2-3 weeks

Place a rigid stabilisation splint for four weeks. Then procline the upper left central and lateral incisors with a removable appliance
The figure below represents an idealised schematic representation of the stress / stain curve relating to Nickel Titanium allloy wire. The arrows indicate
the process of loading the wire during placement and subsequent unloading during tooth alignment. Which of the following most accurately describes
the changes which are occurring in the diagram between B and C?

B
Stress
JF
__ ,

Strain

There is a change from austenitic to martensitic crystal structure

There is a change from martensitic to austenitic crystal structure

There is an increase in stress proportionate to the increase in strain

There is an increase in strain proportionate to the increase in stress

There is controlled unloading of the archwire

A 16-year-old girl presents with a Class IIdivision 1incisor relationship, a 7mm overjet and well aligned arches. She complains that her front teeth stick out.
You are planning camouflage treatment involving the loss of upper first premolars. She questions what effect the extractions will have, as she has read on
the internet that extractions can change your profile. When discussing this, which statement is most accurate?

Removal of the upper first premolars would cause the creation of "dark" buccal corridors

The lay public would perceive that a better facial appearance is produced if treatment is carried upon a non-extraction basis

There would be a significant difference in facial profile produced between a non-extraction approach and the extraction of four first
premolars

Premolar extractions appear to have a small effect on facial profile although not necessarily a detrimental one

The effect of extraction of premolars on facial profile will be greater than that of age changes after the age of 15 years
You have just bonded the brackets pictured for a 15-year-old boy. You have difficulty in opening the bracket on this patient's upper right central incisor
tooth. What is the most appropriate next step?

To check for excess composite incisal to the bracket

To check for excess composite gingival to the bracket

To replace the clip on the bracket

To bypass the bracket when ligating the archwire

To remove the bracket and replace it

A 3-year-old boy attends a cleft multidisciplinary clinic. He has a repaired bilateral cleft lip and palate. The team note mild hyper-nasality to his speech and some
problems with articulation. His mother reports that although the family can understand him, staff at the nursery he attends sometimes struggle to understand
him. What is the most appropriate next step in the management of this patient?

Reassurance - this is normal at this age in this group of patients

Speech and language therapy for six months and then reassess

Nasendoscopy to check the velopharangeal seal

Videofluoroscopy to check the velopharangeal seal

Palatal surgery to create velopharangeal competence

A 16-year-old girl with Down's syndrome attends to have her fixed appliances placed. She has a high saliva flow rate. n addition she has a large
tongue which she struggles to keep away from her teeth. Which orthodontic adhesive is most appropriate for this patient?

Chemical cured composite

Conventional Glass onomer

Light-cured composite

Acrylic cement

Light-cured Glass onomer

A 10-year-old boy with learning disabilities attends for assessment. You observe that he has a mid-face deficiency, a short nose, a low nasal bridge
and ear anomalies. Which teratogen is most likely to have caused these clinical features?

Smoking

Alcohol Cannabis

Vitamin A excess

Vitamin D excess
A 14-year-old boy attends for assessment. He is unhappy about the appearance of his large lower jaw. On examination he has a ClassII incisor
relationship on a moderate Skeletal 3 base. There is mild upper arch crowding and a reverse overjet of -2mm. He cannot achieve
an edge-to-edge incisor relationship. The Lateral Cephalogram confirms the skeletal pattern and shows his upper incisors to maxillary plane angle to be
120° and his lower incisors to mandibular plane angle to be 82°. What is the most appropriate plan for the management of this patient?

Monitor facial growth and reassess once growth is complete

Growth modification with protraction facemask

Upper fixed appliance therapy on a non-extraction basis to align the upper teeth

Orthodontic camouflage with upper and lower fixed appliances and premolar extractions

Decompensation with upper and lower fixed appliances in preparation for orthognathic surgery
You are asked to assess a new index of assessment of orthodontic treatment need. Which of the following options will provide the best test of its
reliability?

elle
Ask the same orthodontist to score the same patient three times on the same day

Ask the same orthodontist to score the same patient on three separate occasions each two weeks apart

Ask the same orthodontist to score several patients at the same time

Ask several orthodontists to score the same patient at the same time

Ask several orthodontists to score the same patient at different times

This 18-year-old female attends a joint orthodontic/orthognathic clinic. Her presenting complaints are her sticking out teeth and small
lower jaw. You will carry out pre-surgical orthodontics followed by orthognathic surgery to achieve full overjet reduction and optimal facial aesthetics.
Which nerve(s) is/are at risk of injury during her surgery?

Nasopalatine nerve

Infraorbital nerve

Inferior dental nerve

Infraorbital and inferior dental nerves

Nasopalatine and inferior dental nerves

This 13-year-old girl attends for assessment. Her upper left deciduous canine is clinically firm. What is the most appropriate first investigation for this girl?

No investigation indicated

Upper standard occlusal

Periapical radiograph

Orthopantomogram

Cone Beam CT
You are planning treatment with fixed appliances for a patient who has Tetralogy of Fallot. What modification to orthodontic management is most
appropriate for this patient?

Orthodontic treatment is contraindicated for this patient

Orthodontic treatment can proceed without any modifications

Orthodontic treatment can proceed, but procedures which may induce a bacteraemia should be avoided

Orthodontic treatment can proceed, but antibiotic prophylaxis prior to any procedure which may induce a bacteraemia is required

Orthodontic treatment can proceed, but antibiotic prophylaxis prior to all appointments to fit, adjust or remove an appliance is
required
You are planning a course of fixed appliance treatment using bands as attachments to the first permanent molars. You plan to use resin modified
glass ionomer cement as your adhesive. What is the most important benefit of using this compared to a conventional glass
ionomer cement?

Chemical adherence to the enamel

Command setting

Leaching of fluoride ions

Lack of moisture sensitivity

Easier removal at debond

This 11-year-old girl attends for assessment. She has delayed exfoliation of the deciduous teeth and an orthopantomogram reveals multiple
supernumerary teeth present.

Which condition is this patient most likely to have?

elle
Ehlers-Danlos Syndrome

Cleft lip and palate

Gardner's Syndrome

Cleidocranial Dysplasia
You have completed placement of upper and lower fixed appliances using a self-etch primer. You placed a 0.012" martensitic stabilised nickel titanium
archwire. The patient returns thirty minutes after their appointment and all the brackets have been lost. On examination, there is no adhesive on the
enamel and all the composite is retained on the brackets. What is the most likely cause for this?

High proportion of aprismatic enamel

Incomplete light cure

Failure to polish before bonding

Traumatic bite

Failure to adequately mix self-etch primer

You have been treating a 13-year-old girl with fixed appliances for correction of her mild Class IIdivision 1malocclusion. She traumatised her upper central
incisors two years before starting treatment. These teeth sustained large enamel/dentine fractures which were restored with composite resin restorations. On
attendance today she reports that the upper left central incisor has recently become tender on biting. What is the most appropriate management of this patient at
this appointment?

To reassure the patient that tenderness is common with fixed braces

To perform vitality testing and take a periapical radiograph if the tooth is non-responsive

To refer the patient to her dentist for root canal treatment

To remove the upper archwire and plan a three month "rest" period

To remove the patient's upper fixed appliance and plan a three month "rest" period
A 16-year-old girl attends fo.- assessment. She complains that her chin is going over to one side and this has been getting progressively worse over the
last two years. Clinically she has an increase in vertical ramus length with a centreline shift and a crossbite on the unaffected side. There is also a
horizontal displacement of the chin to the unaffected side. A furrow has developed at the commissure of the mouth on the affected side. There is no cant
in the occlusal P'lane. What is the most likely diagnosis?

Hemi-mandibular elongation

Juvenile rheumatoid arthritis

Condylar hyperplasia

Hemifacial microsomia

Condylar resorption
You are investigating the effects of a new mouthwash on gingivitis in patients wearing fixed appliances. Your study involves allocating patients wearing
braces to Group A or Group B. The groups will have their gingival health scored at the beginning of the project. Group A will then use the new
mouthwash for 4 weeks and Group B will use a placebo mouthwash. Their gingival health will be reassessed. Then, after a four week period, the
groups will be swapped and again their gingival health measured. What is the most accurate description of this study design?

elle
Cross sectional study

Cross over triaI

Controlled clinical trial

Case control study

Randomised controlled trial

You are investigating the effects of a new mouthwash on gingivitis in patients wearing fixed appliances. Your study involves allocating patients wearing
braces to Group A or Group B. The groups will have their gingival health scored at the beginning of the project. Group A will then use the new
mouthwash for 4 weeks and Group B wiill use a placebo mouthwash. Their gingival health will be reassessed. Then, after a four week period,the groups
will be swapped and again their gingival health measured. What is the most accurate description of this study design?

elle
Cross sectional study
. ...

.. Cross over trial

Controlled clinical trial

....... . Case control study

. Randomised controlled trial

I
You are carrying out an archwire change on a 13-year-old boy who is known to be asthmatic. He is becoming progressively wheezy. He has already taken
several metered doses of his salbutamol inhaler. His respiratory rate has risen to above 25 breaths per minute and he is no
longer able to complete a sentence in one breath. After calling for an ambulance what is the most appropriate next step in management of this patient?

Administer further salbutamol and a steroid inhaler through a spacer if available

Administer high flow oxygen and administer further salbutamol through a spacer if available

Administer high flow oxygen and administer a steroid inhaler through a spacer if available

Administer high flow oxygen and administer O.Sml 1:1,000 adrenaline intramuscularly

Administer high flow oxygen and administer O.Sml 1:10,000 adrenaline intramuscularly
You notice generalised gingival recession in a 30-year-old female patient. She has a crowded Class IIdivision 2 malocclusion with a deep overbite. She
is being treated on a non-extraction basis with upper and lower fixed appliances. Her oral hygiene is good. You notice that she bites her fingernails. What
is the most likely cause of the gingival recession?

Her deep overbite

Age related changes

Proclination of the upper and lower incisorrs during alignment

Her nail biting habit

Her toothbrushing technique

Which of the following best describes the setting reaction of glass iono mer cement?

elle
Free radical polymerisation

Addition polymerisation

Condensation polymerisation

Acid base reaction

Hydrolysis
This patient was born with unilateral cleft lip and palate. What is the most appropriate time to carry out this procedure?

2 - 4 years old

4 - 7 years old

8 - 11years old

12 - 15 years old

16 - 19 years old
You are planning a short course of sectional appliance to align an instanding maxillary incisor.The patient has learning disabilities. They have previously
struggled to maintain a good standard of oral health and, they have some demineralisation present. However, with the help of their carer, they have
recently demonstrated good oral hygiene suitable for a fixed appliance . What is the most important benefit of using glass ionomer cement in this patient?

Direct adherence to bracket

Command setting

Leaching of fluoride ions

Lack of moisture sensitivity

High bond strength

You have comp leted an audit on the quality of SO latera l cepha lometric radiographs in a clinic where you work. You find that 30% are of poor diagnostic quality
mainly due to positioning of the patient in the cephalostat . What is the most appropr iate next step?
eee
Repeat the audit because you feelthat the result is not correct

Ignore the findings because 70% of the radiographs are usable

Arrange to share the information with colleagues to implement change

Arrange for servicing of the cephalostat

Stop taking lateral skull radiographs

A 15-year-old girl attends for an assessment. She has noticeable tooth surface loss particularly affecting the palatal surfaces of the upper
incisors. She complains of sensitivity of these teeth and she has halitosis. On questioning there are no obvious dietary causes for her tooth surface loss and
she does not drink fizzy drinks. Which condition would you be most suspicious of in this girl?

Bruxism

Toothbrush abrasion

Wear from pen chewing

Anorexia

Bulimia
You see an 8-year-old boy for assessment. He has infraocclusion of the upper left and lower left first deciduous molars, with their occlusal surfaces level with
the contact points of the adjacent teeth . You take an orthopantomogram which shows all permanent teeth are present and developing normally. What is
the most appropriate plan for the management of this patient?
eee
Reassure and discharge

No intervention yet and monitor

Ask the dentist to build up the infraoccluded molars to re-establish occlusal contact and monitor

Ask the dentist to extract the infraoccluded molars and monitor

Ask the dentist to extract the infraoccluded molars, provide space maintainers and monitor
You are reviewing the lateral cephalogram of a 12-year-old girl who has been referred for correction of her Class IIdiv 1malocclusion. You have decided against the
use of a functional appliance despite her Smm overjet. Which factor during your cephalometric analysis is most
likely to have influenced this decision?

Reduced anterior facial height

Reduced antegonal notch

Backward inclined condylar head

Increased inter incisal angle

Increased inter molar angle

You are carrying out a study to investigate the use of cannabis on incidence of cleft lip and palate. Your study follows up all pregnant women in a large city from their
initial meeting with the midwife at 9 weeks untilthe birth of their child. nformation is gathered about their socio-economi c background,habits and lifestyle (including
cannabis use both before and during pregnancy). What is the most accurate description of this study design?
eee
Cross sectional study

Controlled clinical trial

Case control study

Cohort study

Cross over study

You are considering changing your bracket system from conventional ligation to self- ligation . What clinical advantage is this change in bracket system
most likely to have?
eee
Itwill be easier to correctly position the brackets

Bonding times will be faster

Adjustmen t of the brace can be achieved more quickly

You will require fewer archwire changes

It will take Jess time to debond the appliance

You see this 5-year-old girl for assessment. She fell at home three days ago and knocked her face on a step. She has lost her upper left deciduous
central incisor tooth together with a segment of alveolar bone. You take the following radiograph:

What is the most appropriate next step in the management of this child?

elle
No intervention,observation only

Extraction of the upper right deciduous central incisor tooth

A sectional fixed appliance on the remaining upper deciduous incisors to hold space in the upper left central incisor region

Open exposure of the upper left central incisor with an apically repositioned fla p
A 35-year-old female patient presents with a Class IIdivision 1malocclusion on a mild Class IIskeletal base and decreased lower facial height. The patient has a
protrusive upper lip but can achieve lip competence. She has no concerns about her facial appearance. Her overjet measures 7mm with maxillary incisors angled
at 125 degrees to the maxillary plane and mandibular incisors at 92 degrees to the mandibular plane. What is the most appropriate plan for reduction of her
overjet?

Upper incisor retroclination

Lower incisor proclination

Mandibular advancement surgery

Maxillary set back surgery

Maxillary advancement surgery

This 11-year-old boy attends for assessment. Since his upper left permanent canine is unerupted you take the following radiographs. After discussing the
treatment options he explains that he is unwilling to wear fixed appliances. You accept his and his parent's assurance that he will not change his mind about
this in the future. What is the most appropriate plan for management of the canine?

Leave in .situ and monitor radiographica lly at six monthly intervals in the hope that it will improve in posit on

Leave in .situ and monitor radiographica lly at twelve monthly intervals in the hope that it will improve in position

Leave in .situ and monitor radiographica lly at two yearly intervals in the hope that it will improve in position

Refer for surgical extraction for the tooth

Allow the·tooth to erupt palatally and then extract on eruption

A 15-year-old girl is in the middle of fixed appliance treatment. Her mother asks to speak to you privately as she suspects her daughter may be self-harming. What
advice would it be most appropriate to give to the girl's mother at this time?
eee
That you have a duty to inform the local child protection services that the child is at risk

That it would be inadvisable to discuss her suspicions with her daughter and she should wait until her daughter approaches her

That support is available from various agencies and that she should approach her doctor to access this support

That continuation of orthodontic care is inadvisab le at this point and that you would like to remove the appliances until her daughter has
stopped self-harming

That because the patient herself has not disclosed that she is self-harming you are unable to offer any advice
You have just fitted a banded Rapid Maxillary Expander (RME) in a 12-year-old girl in order to manage her bilateral buccall crossbite. You have advised her to turn
the screw twice daily. What is the most appropriate follow-up regime?

Reviewin 1day

Reviewin 1week

Reviewin 4 weeks

Reviewin 3 months

Review once a midline diastema has appeared

This 40-year-old female attends for treatment. She has opted for this ceramic bracket and coated archwire combination. She is extremely concerned about
aesthetics. As well as discolouration of the elastomeric modules,what aesthetic compromise is this patient most likely to experience?

Discolouration of the brackets

Staining of the composite around the brackets

Loss of coating on the aesthetic archwire·

Interproxima l staining

Cervical staining
A 15-year-old boy attends for a Twin Block appliance review. The appliance has been worn on and off for the last year. Examination reveals a Class IIDivision
1malocclusion on a severe Skeletal 2 base with increased vertical proportions. The overjet has not changed at 10 mm, the molar relationship is a full unit
Class IIbilaterally, there is mild upper and lower arch crowding and oral hygiene is good. The patient is very unhappy about the appearance of his prominent
front teeth and small lower jaw . What is the most appropriate next step in the management of this patient?

Cease current treatment due to poor compliance and discharge

Encourage increased functional appliance wear and review in 8 weeks

Orthodontic camouflage with upper and lower fixed appliances and extraction of a 1st premolar in all four quadrants

Orthodontic camouflage with upper and lower fixed appliances and extraction of a 1st premolar in the upper right and upper left quadrants only

Cease current treatment and review in 12 months' time to consider a combined orthodontic and orthognathic surgery approach
A 13-year -old boy presents with a swelling on the dento-alveolar ridge distal to the fully erupted lower left first permanent molar tooth. He is aware that the
swelling has been slowly getting bigger over the last few months. On periodontal probing distal to the first permanent molar there is a deep pocket which
can exude a white, thick, slightly oily substance. The radiographs show a 6-7 mm circumscribed radiolucency surrounding the crown of the unerupted lower
le·ft second permanent molar and some distaldisplacement of the developing third molar tooth. What is the most appropriate next step in the management
of this patient?

Monitor

Marsupialisation

Open exposure of the lower left second permanent molar

Closed exposure of the lower left second permanent molar and placement of gold chain

Surgical removal of the lower left second permanent molar along with the overly ing lesion
A 9-year-old girl presents with pain associated with her lower left first permanent molar. She has a Class IIDivision 1malocclusion on a mild Class 2 skeletal
base,with well aligned arches, proclined upper incisors and a 10 mm overjet. Both lower first permanent molars are severely hypoplastic and both upper
first permanent molars are mildly hypoplastic. All successor teeth are radiographically present
including third molars. The bifurcation of the roots of the lower second permanent molars is evident. What is the most appropriate advice to give to your paediatric
dentistry colleagues in the management of this patient?

Advise restoration of all first permanent molars with a view to maintaining them in the Jon g-term

Advise restoration of all first permanent molars in the short-term and plan the extraction of all four first permanent molars as part of
orthodontic treatment in the permanent dentition

Advise extraction of only the lower left first permanent molar now and plan the extraction of the remaining first permanent molars as part of
orthodontic treatment in the permanent dentition

Advise extraction of both lower first permanent molars now and plan the extraction of the upper first permanent molars as part of orthodontic
treatment in the permanent dentition

Advise all first permanent molars are extracted now

This 6-year-old child attends for assessment. Their dentist has noticed the unusual appearance of the upper right central and upper left lateral deciduous
incisor teeth. What is the most appropriate next step in the management of this patient?

No treatment . Take an orthopantomogram and review in six months

No treatment. Take an upper occlusal radiograph and review in twelve months

No treatment . No radiographs at this stage but assess for these at review in twelve months

Take an upper occlusal radiograph. Arrange for extraction of both the upper right central and upper left lateral deciduous incisor teeth and
review in twelve months

Take an orthopantomogram . Arrange for extraction of both the upper right central and upper left lateral deciduous incisor teeth and
review aged 11
This is a cephalometric tracing of an adult female with minimal crowding. She is planned for a mandibular advancement osteotomy.
What is the most likely extraction pattern and elastic wear for this patient in preparation for her orthognathic surgery?

Upper premola r extractions, Class IIIelastics

Non-extraction,Class IIIelastics

Lower premola r exlraclions, Class III elaslics

Upper premola r extractions, Class IIelastics

Non-extraction,Class IIelastics
What is the most appropriate frequency for initiating the free radical polymerisation of a composite bonding agent?

elle
120 - 200 nanometres

240 - 300 nanometres

360 - 400 nanometres

480 - 540 nanometres

600 - 720 nanometres

A 9-year-old boy is referred by his dentist for assessment. His dentist is concerned that his upper left central incisor tooth has not come through and feels
interceptive treatment is required. His mother contacts you one week before the appointment to express concerns about attending the appointment . Her
son is autistic and he will find the appointment difficult. He does not like meeting new people and struggles
in busy public places. He can become aggressive and hit people when upset. What is the most appropriate way to manage this situation?

Cancel the appointment and ask the mother to reschedule when the patient is older and better able to cooperate

Cancel the appointment. Ask the dentist to take a periapical radiograph and to refer directly to the maxillofacial team for management
under general anaesthetic if there is an obvious obstructive cause for the unerupted incisor

Keep the planned appointment and ask the mum to bring adequate support in order that your staff will remain safe if the patient
becomes physically violent

Find out more information about the boy's preferences and needs. Arrange an exploratory visit to the department at a quiet time.
Make adjustments on the day of his visit to minimise anxiety

Liaise with the child mental health team to medicate the child on the day to ensure the safety of you and your team
A 20-year-old female patient attends for assessment on a joint orthodontic/orthognathic clinic. She has a significant Class IImalocclusion and
requests "jaw surgery" which she has looked up on the internet and YouTube. She has previously been diagnosed with psychological
issues. She has no family support and she attends with a social worker. What is the most appropriate plan for this patient?

No treatment can be offered

Liaise with her doctor to arrange for psychotherapy to help her come to terms with her Class III malocclusion. Do not offer orthognathic
treatment

Offer her compromise treatment using orthodontics alone to align her teeth. Do not offer orthognathic treatment Offer orthognathic

surgery without pre-surgical orthodontics if social services confirm they can provide care in the
immediate post-operative recovery period

elle Offer orthognathic surgery only after a psychological assessment and if social services confirm that they can provide support in
the immediate post-operative recovery period
You see a 5-year-old girl for assessment. She is currently in foster care and her carer explains that she came from a poor socioeconomic background.
Her mother smoked and drank throughout pregnancy and may have used drugs, in addition her living conditions were poor. The girl has a cleft lip and
palate. Which teratogen is most likely to have contribut·ed to her cleft lip and palate?

elle
Alcohol

Cigarette smoke

Toxoplasma

Cannabis

elle
Valium
This 15-year-old girl had her fixed appliance fitted six months ago. Despite making space for the upper left permanent canine it has failed to erupt. The
patient wants to speed things up. What is the most appropriate next step in managing this patient?

Open exposure of the upper left canine

Open exposure of the upper left canine and placement of a gold pad and chain to aid eruption

Closed exposure of the upper left canine and placement of a gold pad and chain on the palatal surface to aid eruption

Closed exposure of the upper left canine and placement of a gold pad and chain on the buccal surface to aid eruption

Exposure of the upper left canine using an apically repositioned flap

You see this 12-yea r-old girl for assessment. The swelling on the left side of her lower lip is 6mm in diameter and fluctuant. t appeared 2 months ago after she
bit her lip. What is the most appropriate next step in the management of this child?

No intervention,it should spontaneously resolve within 5 days

Ask the patient to leave her lower appliance out for 5 days and review

Ask the patient to "pop" the swelling with a pin

Non-urgent referral for removal of the swelling and associated salivary gland

Urgent referral for biopsy

An 11-year-old boy attends as an emergency. He is being treated with an upper removable appliance with an anterior bite platform to help reduce palatal
trauma from the lower incisors. The appliance has fractured for the third time in the area of the bite platform. Cold cure acrylic was used in the manufacture of
the appliance and subsequent repairs. What is the most appropriate next step for this patient?

To repair the appliance using the same materials and ask the patient to be more careful

To repair the appliance using the same materials but thickening the anterior bite platform

To replace the appliance using the same design and materials

To replace the appliance with the same materials but extending the bite platform to gain full occlusal coverage

To replace the appliance using the same design and heat cured acrylic
A SS-year-old woman attends for assessment. She has a 10 mm overjet which would ideally be corrected through a combination of orthodontic
alignment and orthognathic surgery. She has a previous history of breast cancer and has taken steroids within the last two years and oral
bisphosphonates within the last three years. She had a short course of fixed appliance treatment as a teenager. Which factor
is most important in deciding whether treatment can be offered?

The patient's age

The magnitude of the overjet

The patient's history of steroid use

The patient's history of bisphosphonate use

The patient's history of previous orthodontic treatment

This 19-year-old female has severe learning difficulties and has traumatised upper incisors. She has been brought by her carer for advice on how
to straighten and restore her teeth. She is in full-time· residential care because her mother is physically disabled and her father works long hours
away from home. After giving a clear and detailed description of the various treatment options, as well as the consequences of leaving either her
malocclusion or her traumatised teeth uncorrected, the patient is judged not to have capacity to give consent. n this situation, who is legally the
most appropriate person to give consent for the patient?

No one else may consent on behalf of the patient

The father, especially if the mother is unable to attend the consultation and he is judge d to have capacity

The mother, if she is able to attend her daughter's consultation to hear the treatment options and be judged to have capacity

The carer, because with the mother's disability and the father's work commitments, neither parent can easily attend

elle The orthodontist and another independent clinician who concur on a treatment plan that has been compiled with the best
interests of the patient in mind
You fitted a twin block functiona l appliance for a 13-year-old girl two days ago. She contacts you as she is in severe discomfort; one of the Adams clasps
is catching on the gingival tissues of a lower molar. You are unable to offer her an appointment until tomorrow. What is the most appropriate next step in
the management of this patient?

Advise her to use wax and persevere with the brace untilyou can see her tomorrow

Advise her to use of Bonjela and persevere with the brace until you can see her tomorrow

Advise non-steroidal anti-inflammatories and persevere with the brace untilyou can see her tomorrow

Advise her to remove the lower appliance for 24 hours. Try again with the appliance tomorrow and contact you if it is still uncomfortable

Advise her to remove both appliances until you can sec her tomorrow
A 14-year-old boy attends for adjustment of his fixed appliances. He experienced an enamel-dentine fracture to the upper left central
incisor around 2 years prior to the start of treatment. You take a radiograph 6 months into treatment to check the periapical status of this incisor and notice
significant resorption of the roots of all four upper incisors has occurred. Which of the following strategies will be most effective in minimising further resorption
in this case?

Replacing the brackets on the upper incisors with self-ligating brackets

Pausing active treatment for at least 3 months

Avoiding the use of steel archwires in the upper arch

Using NiTi coilsprings to close spaces rather than powerchain

Removing the fixed appliances and continuing treatment with removable aligners
This 13-year-old boy attends for assessment. He and his mother are unaware of any problem with his teeth. You note that he has no upper incisor show
with his lips at rest. His medical history is unremarkable with no problems that would affect any prospective orthodontic treatment. There is no significant
crowding in the upper or lower arches. His general dental condition and his oral hygiene are good. His motivation is good and he will cooperate with
treatment. These images were taken on the same day, before any treatment was started.
What is the most accurate description of this patient's malocclusion?

A mild Class IIskeletal malocclusion with a reduced lower face height and a forward mandibular displacement on closure

A moderate Class IIskeletal malocclusion with a reduced anterior lower facial height with no mandibular displacement on
closure

A moderate Class IIskeletal malocclusion with an average lower facial height and no mandibular displacement

A severe Class IIIskeletal malocclusion with an average lower face height with no mandibular displacement

A severe skeletal Class IIImalocclusion with a reduced anterior lower facial height and a forward mandibular
incisor show with h!S hps at rest. His medical history 1s unremarkable with no problems that would affect any prospective orthodontic
treatment. There is no significant crowding in the upper or lower arches. His general dental condition and his oral hygiene are good. His motivation is
good and he will cooperate with treatment. These images were taken on the same day, before any treatment was started. What is the most accurate
description of this patient's malocclusion?

A mild Class IIskeletal malocclusion with a reduced lower face height and a forward mandibular displacement on closure

A moderate Class IIskeletal malocclusion with a reduced anterior lower facial height with no mandibular displacement on closure

A moderate Class IIskeletal malocclusion with an average lower facial height and no mandibular displacement

A severe Class IIIskeletal malocclusion with an average lower face height with no mandibular displacement

A severe skeletal Class IImalocclusion with a reduced anterior lower facial height and a forward mandibular displacement on
closure
You plan to use a heat sensitive martensitic active archwire for initial alignment during fixed appliance treatment. What metal is responsible for the heat
active properties of this archwire?

Titanium

Copper

Stainless Steel

Molybdenum

Nickel
You are in the finishing stages of an orthodontic treatment which required extractions; all spaces are closed. You have used a 0.022 x 0.028" slot pre-
adjusted edgewise bracket system. You choose a 0.021 x 0.025" beta titanium alloy archwire as you require third order expression of the bracket
prescription at this finishing stage. What property of this wire is of greatest value to you in this situation?

High friction

Good formability

Low modulus of elasticity

Low range

Immediate force delivery

You have been asked to review the quality of treatment outcomes for a group of localorthodontists. You ask them to provide Peer Assessment Rating
(PAR) percentage improvement scores for 30 consecutively completed cases. One orthodontist has consistent PAR finish scores of between 2 and 6.
However, his nomogram of PAR improvement shows a high number of cases in the "no different/worse" or "improved" zones. What is the most likely
explanation for these results?

He treats a large number of patients with hypodontia

He treats a large number of orthognathic patients

He treats a large number of patients with cleft lip and palate

He treats a large number of simple cases with low initial PAR score

He treats a large number of patients with high initial PAR score

You see a 15-year-old boy for adjustment of his fixed braces. He has a Class IIDivision 1malocclusion and underwent extraction of both upper first premolars.
You are in the space closure stage of treatment, using powerchain. A 2 mm space remains on each side, distal to the upper lateral incisors. The spaces have not
closed at all over the last 3 visits. What is the most likely reason for the lack of space closure in this case?

Powerchain is being used to close the spaces and this is less effective than NiTi coil springs

There is a tooth size discrepancy

The overbite has not been fully reduced prior to beginning space closure

The patient has a nail biting habit

The patient has poor oral hygiene

Which of the following options best describes the analysis being carried out on this patient's lateral cephalogram?

Down's Analysis

Sassouni Analysis

Harvold Analysis

Ricketts Analysis

Wits Analysis
This 16-year-old boy presents with a Class Imalocclusion that is complicated by an anterior open bite involving the upper incisors and measuring 4mm at
its worst point. He and his parents are keen to avoid orthognathic surgery. What is the most likely reason for placement of the temporary anchorage
devices (TADs) in the positions shown?

To provide vertical anchorage against which the incisors can be extruded and retracted

To provide transverse anchorage against which the buccal segments can be expanded

To provide vertical anchorage against which the buccal segments can be extruded

To provide transverse anchorage against which the buccal segments can be contracted

To provide vertical anchorage against which the buccal segments can be intruded
A 12-year-old boy attends to start treatment. He has a Class IIDivision 1malocclusion with crowding in the upper and lower arches. He has had four
premolar teeth extracted and is due to have fixed appliances fitted today. He explains that he traumatised his upper front teeth 3 weeks ago and this
resulted in the extrusion of the upper right permanent central incisor by 2 mm. What is the most appropriate next step in the management of this patient?

Proceed with the bond up as planned

Delay the bond up for 1month

Delay the bond up for 3 months

Delay the bond up for 6 months

Cancel treatment, it is inappropriate to proceed with orthodontic treatment at any time

This 16-year-old girl presents with a Class IIdivision 1malocclusion with an overjet of Smm. She and her parents are keen to avoid orthognathic surgery. How are the temporary
anchorage devices pictured most likely to aid the correction of this patient's malocclusion?

By providing direct anchorage against which to retract the upper labial segment

By providing indirect anchorage to intrude the upper first molars

By providing direct anchorage to intrude the upper first molars

By providing indirect anchorage against which to retract the upper labial segment

By providing direct anchorage to constrict the upper molars

An 11-year-old severely autistic girl attends for assessment. She is unable to talk, however, she is cooperative, copes well with dental treatment and her father feels she
could cope with orthodontic treatment should it be needed. On examination she is in the late mixed dentition has a Class IIdivision 2 incisor relationship with a 6 mm overjet
to the upper latera l incisors, a deep overbite, mild upper arch crowding, mild infraocclusion of the upper left second deciduous molar tooth and a posterior crossbite without
displacement. An orthopantomogram shows all permanent teeth to be present. The upper right permanent canine is palatally impacted. Since the patient is unable to
communicate her concerns you have agreed to only carry out treatment if it will have an impact on oral health. Which occlusal trait would have the greatest impact on your
decision to recommend orthodontic treatment?

Her 6 mm overjet

Her increased overbite

Her posterior crossbite

Her infraoccluded second deciduous molar tooth

Her impacted upper permanent canine tooth

A 32-year-old female attends for assessment. She has a Class IIDivision 1incisor relationship on a mild Skeletal 2 base complicated by moderate crowding. On
examination,there are periodontal pocket depths greater than 5 mm in her upper buccal sextants, with associated bleeding on probing. Standards of oral hygiene are fair. There
are calculus deposits on the lingual surface of the lower labial segment. She has a thin gingival biotype but no recession. Radiographic examination reveals moderate horizontal
bone loss associated with the upper permanent molars. What periodontal care is required before proceeding with orthodontic treatment?

Oral hygiene instruction

Oral hygiene instruction and supragingival scaling

Oral hygiene instruction,supragingival scaling and subgingival scaling

Oral hygiene instruction,supragingival scaling, subgingival scaling and a periodonta l stabilisation period

Oral hygiene instruction,supragingival scaling, subgingival scaling, gingival grafting and a periodontal stabilisation period
You are approached by a maxillofacialcolleague . He is having problems with bond failures of the button and gold chain placed during the closed exposure of canines. His protocol is:

• Etch with 37% phosphoric acid for 30 seconds

• Wash for 30 seconds
• Apply bond and light cure for 5 seconds
• Apply chemically cured composite

What change in his protocol is most likely to reduce his bond failure rate?

Etch for 15 seconds

Wash for 15 seconds

Do not use the bond

Do not light cure the bond

Use light cured composite

You are asked by your maternity colleagues to see this newborn child. Which member of the multidisciplinary team will have the greatest input in the care of this child at this stage?

Cleft surgeon

Orthodontist

Speech therapist

Paediatric dentist

Specialist cleft nurse

A 14-year-old girl attends for adjustment of her fixed appliances. She has decalcificat ion present and on questioning she is drinking large quantities of sugared fizzy drinks.
You decide to remove her fixed braces immediately. Her unilateral posterior crossbite has been corrected with upper arch expansion and her arch alignment is now
reasonable, However, her overbite is not fully reduced and her occlusa l
intercuspation is not ideal. What is the most appropriate retainer for her upper arch?

No retention appliance, due to poor compliance with fixed appliances

An upper anterior bonded retainer wire only

An upper vaccum formed retainer

An upper Hawley retainer

A positioner
The parents of a child with an x-linked recessive disorder attend a craniofacial clinic. The father is unaffected and a mother is an unaffected carrier. They wish to know
how likely they are to pass on the condition to their children. Which option best describes the probable distribution of the condition amongst their children?

50% of sons affected, 50% of daughters affected

100% of sons affected, 50% of daughters affected

50% of sons affected, 100% of daughters unaffected carriers

50% of all children affected, 50% of all chi ldren unaffected carriers

50% of sons affected, 50% of daughters unaffected carriers