ORE Part 2 Oral Surgery & Extractions 1 — Questions and Answers
Question 1: What is the most common complication following a mandibular third molar extraction?
- Dry socket (alveolar osteitis) (Correct answer)
- Permanent inferior alveolar nerve injury
- Jaw fracture
- Ludwig's angina
Correct answer: Dry socket (alveolar osteitis)
Dry socket (alveolar osteitis) is the most common post-extraction complication, occurring in 2–5% of routine extractions and up to 30% of lower third molar removals.
Question 2: What landmark must be identified to deliver an inferior alveolar nerve block (IANB)?
- Pterygomandibular raphe and coronoid notch (Correct answer)
- Mental foramen only
- Greater palatine foramen
- Retromolar pad
Correct answer: Pterygomandibular raphe and coronoid notch
The IANB is delivered medial to the pterygomandibular raphe, at the level of the coronoid notch (deepest concavity of the anterior ramus), guiding the needle to the mandibular foramen.
Question 3: In the Pell and Gregory classification, a Class C position of a lower third molar indicates?
- The tooth is level with or below the cervical line of the second molar (Correct answer)
- The tooth is level with the occlusal plane
- The tooth is partially erupted above the occlusal plane
- Horizontal impaction
Correct answer: The tooth is level with or below the cervical line of the second molar
Pell and Gregory Class C means the highest point of the third molar is below the cervical line (CEJ) of the adjacent second molar, indicating deep impaction.
Question 4: What is the most appropriate management of a tooth with a periapical abscess and severe bone loss in a medically compromised patient on bisphosphonates?
- Thorough assessment and MDT discussion before extraction; consider endodontic treatment (Correct answer)
- Immediate extraction without consultation
- Prescribe antibiotics and delay all treatment indefinitely
- Refer to oral medicine only
Correct answer: Thorough assessment and MDT discussion before extraction; consider endodontic treatment
Bisphosphonate therapy creates risk of medication-related osteonecrosis of the jaw (MRONJ); extraction decisions require MDT input, ideally endodontic treatment is preferred to avoid extraction.
Question 5: Which instrument is used to section a lower third molar before removal to reduce trauma?
- Surgical handpiece with a fissure bur (Correct answer)
- Coupland's elevator
- Warwick James elevator
- Mitchell's trimmer
Correct answer: Surgical handpiece with a fissure bur
A surgical handpiece with a fissure bur is used to section the crown or roots of a lower third molar, reducing the surgical access required and minimising trauma.
Question 6: What is the Gustafson and Koch formula used for in oral surgery?
- Estimating age from dental features (root resorption, attrition, etc.) (Correct answer)
- Calculating anaesthetic doses
- Grading impaction difficulty
- Assessing fracture risk
Correct answer: Estimating age from dental features (root resorption, attrition, etc.)
The Gustafson method estimates age from histological and radiographic dental features including attrition, secondary dentine, cementum apposition, root resorption, and root translucency.
ORE Part 2 Oral Surgery & Extractions 1
What is the most common complication following a mandibular third molar extraction?