Restorative & Materials · patient case question
Before preparing tooth #8 for a crown, what is the most appropriate FIRST step?
Patient case: Crown preparation in a patient with epilepsy and autism
Patient: Male, 27 years old
Chief Complaint: Accompanied by his mother, who requests a crown for a fractured upper front tooth.
Background: Autism spectrum disorder and generalised tonic-clonic epilepsy. Last seizure four months ago. Takes levetiracetam. Communicates in short phrases and repeats them; sensitive to bright light and loud sound.
Vital Signs: BP 118/74 mmHg · HR 78 bpm
Findings: Tooth #8 has a large failing composite with a fracture line. Heavy wear on the anterior teeth. Rest of the dentition intact.
Show answer and explanation
Correct answer: B. Analysis of the occlusion
- A. Shade is selected early in the appointment, before the teeth dehydrate, but it is not a diagnostic step and it does not change the treatment plan.
- B. CORRECT. The anterior wear tells you the fracture was not an accident — something in the occlusal scheme broke this tooth, and a crown placed into that same scheme will fracture too. Occlusal analysis comes first: mounted casts if needed, evaluation of anterior guidance and excursive contacts, and a decision about whether the vertical dimension or the guidance must change before any preparation is cut.
- C. The provisional is fabricated from a matrix taken AFTER the diagnostic workup and preparation design are settled — it is a step, not the first step.
- D. Retraction cord is placed at impression-taking, after the preparation is complete.
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