Overseas Registration Exam (ORE) Clinical Dentistry and Operative Procedures Syllabus

Clinical Dentistry and Operative Procedures syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Clinical Dentistry and Operative Procedures in Overseas Registration Exam (ORE), not a summary of it.

1. 1

   Dental Caries and Restorative Management

   5 topics

   • Caries Diagnosis and Risk Assessment
     • Visual-tactile and radiographic detection (ICDAS)
     • Caries risk profiling and recall intervals
     • Remineralisation and non-operative management
   • Cavity Preparation Principles
     • Minimally invasive and biological caries removal
     • Black's classification and contemporary alternatives
     • Pulp protection, liners and bases
   • Direct Restorative Materials
     • Resin composites and adhesive bonding systems
     • Glass ionomer and resin-modified GIC
     • Amalgam handling and mercury safety regulations
   • Indirect Restorations
     • Inlays, onlays and partial coverage
     • Crown preparation and provisionalisation
     • Impression techniques and digital scanning
   • Management of the Worn and Failing Dentition
     • Tooth surface loss: erosion, attrition, abrasion
     • Occlusal vertical dimension and the Dahl concept
2. 2

   Endodontics

   5 topics

   • Pulpal and Periapical Diagnosis
     • Pulp sensibility testing and diagnostic terminology
     • Differential diagnosis of odontogenic pain
   • Root Canal Anatomy and Access
     • Canal morphology and aberrant anatomy
     • Access cavity design and isolation with rubber dam
   • Canal Preparation and Disinfection
     • Working length determination and apex locators
     • Mechanical instrumentation and irrigation protocols
   • Obturation and Restoration of Endodontically Treated Teeth
     • Obturation techniques and sealers
     • Post and core, coronal seal and fracture risk
   • Endodontic Complications and Re-treatment
     • Iatrogenic errors: perforation, ledging, separated instruments
     • Indications for surgical endodontics and referral
3. 3

   Fixed and Removable Prosthodontics

   5 topics

   • Treatment Planning for Tooth Replacement
     • Assessment of edentulous and partially dentate patients
     • Choice between fixed, removable and implant options
   • Complete Dentures
     • Impressions, jaw registration and the occlusal plane
     • Aesthetics, retention and post-insertion problems
   • Removable Partial Dentures
     • Kennedy classification and design principles
     • Surveying, rests, clasps and connectors
   • Fixed Bridgework
     • Resin-bonded and conventional bridge design
     • Abutment selection and pontic design
   • Occlusion and Articulation
     • Centric relation, intercuspal position and guidance
     • Temporomandibular disorders and occlusal appliances
4. 4

   Periodontology

   5 topics

   • Periodontal Examination and Classification
     • BPE screening and full periodontal charting
     • 2017 classification of periodontal and peri-implant diseases
   • Aetiology and Risk Factors
     • Plaque biofilm and host response
     • Smoking, diabetes and systemic associations
   • Non-Surgical Periodontal Therapy
     • Oral hygiene instruction and behaviour change
     • Subgingival instrumentation and re-evaluation
   • Surgical and Advanced Management
     • Indications for periodontal surgery
     • Furcation, mucogingival and regenerative procedures
   • Supportive Periodontal Care and Peri-Implant Disease
     • Maintenance recall and prognosis
     • Peri-implant mucositis and peri-implantitis

Clinical Dentistry and Operative Procedures flashcards for Overseas Registration Exam (ORE)

22 of 54 cards from the Clinical Dentistry and Operative Procedures deck — real questions with worked answers.

1. What are the four key components assessed in caries risk assessment using a tool such as CAMBRA or the Cariogram?

   Disease indicators (existing/recent lesions), risk factors (bacterial load, frequent fermentable carbohydrate, hyposalivation), protective factors (fluoride, saliva flow, antibacterials), and the resulting balance that classifies the patient as low, moderate, high or extreme risk.

2. Describe the ICDAS scoring scale (0-6) for visual caries detection.

   0 = sound; 1 = first visual change in enamel (seen only after drying); 2 = distinct visual change in enamel (wet); 3 = localised enamel breakdown without dentine; 4 = underlying dark shadow from dentine; 5 = distinct cavity with visible dentine; 6 = extensive cavity with visible dentine over more than half the surface.

3. What critical pH values define demineralisation for enamel and for root/dentine surfaces?

   Enamel (hydroxyapatite) demineralises below a critical pH of approximately $5.5$; root surface and dentine demineralise at a higher critical pH of approximately $6.2$ because of their greater carbonate content and lower mineral density.

4. List the white-spot (early enamel) lesion management options that avoid operative intervention.

   Topical fluoride (varnish $\ce{5\%}$ NaF, high-fluoride toothpaste), dietary advice to reduce frequency of fermentable carbohydrate, improved oral hygiene/plaque control, fissure sealants, and resin infiltration (e.g. Icon) for non-cavitated proximal lesions.

5. State Black's six classes of cavity classification.

   Class I: pits/fissures (occlusal, buccal/lingual pits). Class II: proximal surfaces of posterior teeth. Class III: proximal surfaces of anterior teeth not involving the incisal angle. Class IV: proximal surfaces of anterior teeth involving the incisal angle. Class V: cervical/gingival third of any tooth. Class VI: incisal edges or cusp tips.

6. What are the classic principles of cavity preparation described by G.V. Black?

   Obtain outline form, resistance form, retention form, convenience form, removal of remaining carious dentine, finishing of enamel walls/margins, and toilet (cleansing) of the cavity.

7. Differentiate resistance form from retention form in cavity preparation.

   Resistance form is the shaping (flat pulpal floor, adequate bulk, rounded internal line angles) that enables tooth and restoration to withstand occlusal forces without fracture. Retention form is the shaping (parallel/undercut walls, dovetails, grooves) that prevents the restoration from being displaced or dislodged.

8. Compare the principles of minimally invasive (biological) cavity design with traditional G.V. Black design.

   Minimally invasive design removes only caries and unsupported enamel, preserves sound tooth structure, relies on adhesion rather than mechanical 'extension for prevention', and uses smaller, defect-oriented preparations. Black's design extended margins into self-cleansing/caries-immune areas and depended on mechanical retention.

9. Give the typical powder:liquid setting reaction and key clinical advantage of glass ionomer cement (GIC).

   GIC sets by an acid-base reaction between fluoroaluminosilicate glass powder and polyacrylic acid, forming a polysalt hydrogel matrix. Key advantages: chemical adhesion to tooth (ion exchange with enamel/dentine), fluoride release/recharge, and biocompatibility; main drawbacks are low fracture toughness and moisture sensitivity during set.

10. What is the difference between total-etch and self-etch dentine bonding strategies?

    Total-etch (etch-and-rinse) uses separate phosphoric acid ($\ce{H3PO4}$, ~$37\%$) to demineralise enamel and dentine before primer/adhesive. Self-etch uses acidic monomers that simultaneously etch and prime without a rinse step, leaving smear layer incorporated; it gives more reliable dentine bonds with less postoperative sensitivity but weaker enamel etch.

11. What causes polymerisation shrinkage stress in resin composite and how is it clinically minimised?

    Conversion of monomer to polymer reduces intermolecular distance, producing volumetric shrinkage (~$2\text{-}3\%$) and contraction stress at the bonded interface. Minimised by incremental layering, controlling the C-factor (bonded:unbonded surface ratio), soft-start/ramp curing, using low-shrink/bulk-fill materials, and a stress-relieving flowable liner.

12. Compare amalgam and resin composite as direct posterior restorative materials.

    Amalgam: high compressive strength, durable, technique-tolerant, not adhesive (needs mechanical retention), non-aesthetic, mercury/environmental concerns. Composite: tooth-coloured, adhesive (conservative prep), bonds and reinforces tooth, but technique-sensitive, polymerisation shrinkage, higher wear in large stress-bearing cavities, and longer placement time.

13. What features define an ideal indirect inlay/onlay preparation compared with a crown?

    Inlay/onlay: tapered (6-10 degrees total convergence) walls for draw, no undercuts, smooth rounded internal line angles, defined margins; onlay covers/protects cusps. A crown additionally requires circumferential reduction with adequate occlusal ($1.5\text{-}2\,\mathrm{mm}$) and axial ($1\text{-}1.5\,\mathrm{mm}$) reduction and a defined finish line for the chosen material.

14. Compare a chamfer, shoulder, and bevelled-shoulder finish line for crowns.

    Chamfer: conservative, suited to metal/PFM metal collars and zirconia, clear margin. Shoulder ($90^\circ$): provides bulk for porcelain/all-ceramic strength and aesthetics. Bevelled shoulder: adds a bevel to a shoulder to improve marginal seal for metal margins, but contraindicated for all-ceramic.

15. What is the difference between a glass-ceramic (e.g. lithium disilicate) and zirconia restoration in terms of strength and bonding?

    Lithium disilicate (e.g. e.max) flexural strength ~$360\text{-}400\,\mathrm{MPa}$, etchable with hydrofluoric acid and adhesively bonded, excellent aesthetics. Zirconia ~$900\text{-}1200\,\mathrm{MPa}$ (yttria-stabilised), much stronger, can be conventionally cemented, but is not HF-etchable (needs tribochemical/MDP primer) and is less translucent (monolithic vs layered).

16. What are the recognised aetiological categories of tooth surface loss (tooth wear)?

    Attrition (tooth-to-tooth contact, e.g. bruxism), abrasion (mechanical wear from foreign objects, e.g. toothbrush/abrasive paste), erosion (chemical dissolution by acids, intrinsic e.g. GORD/vomiting or extrinsic e.g. dietary), and abfraction (cervical loss attributed to occlusal flexural stress).

17. What is the Dahl concept in management of the localised worn dentition?

    Placing localised restorations (or an appliance) in supra-occlusion on the worn anterior teeth so that, over weeks-months, relative axial tooth movement (intrusion of contacted teeth and eruption of posterior teeth) re-establishes posterior occlusal contacts, creating interocclusal space for restorations without removing tooth tissue or increasing the OVD operatively.

18. How is pulpal status clinically classified, and what do the categories mean?

    Normal pulp (responds within normal limits, no symptoms); reversible pulpitis (short, sharp pain to stimulus that subsides, no spontaneous pain); irreversible pulpitis (lingering/spontaneous pain, often heat/cold provoked); pulp necrosis (no response to sensibility testing); and previously treated/previously initiated therapy.

19. Distinguish symptomatic from asymptomatic apical periodontitis and an acute apical abscess.

    Symptomatic apical periodontitis: painful periapical inflammation, tender to percussion, may show widened PDL. Asymptomatic apical periodontitis: periapical radiolucency without symptoms. Acute apical abscess: rapid onset, spontaneous pain, swelling, pus, tenderness, possible systemic involvement (pyrexia, lymphadenopathy).

20. Contrast pulp sensibility tests with pulp vitality tests.

    Sensibility tests (cold/Ets thermal, electric pulp test) assess nerve response and only indirectly infer vitality. True vitality tests (laser Doppler flowmetry, pulse oximetry) assess actual pulpal blood flow, so they remain valid even when nerve response is absent (e.g. recently traumatised or immature teeth).

21. State the average root canal numbers for the maxillary first molar and mandibular first molar.

    Maxillary first molar: 3 roots, commonly 4 canals (MB1, MB2, DB, palatal) — the MB2 is frequently present (>$50\%$). Mandibular first molar: 2 roots, commonly 3-4 canals (mesiobuccal, mesiolingual, and one or two distal canals).

22. What are the objectives and ideal features of an endodontic access cavity?

    Objectives: straight-line access to canal orifices, complete removal of the pulp chamber roof, conservation of sound tooth, and location of all canals. Ideal access removes all caries/old restoration, has divergent walls for visibility, smooth funnelled orifices, and an outline reflecting the pulp chamber floor anatomy.

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