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Master Dentistry
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Master Dentistry
Volume 2: Restorative Dentistry,
Paediatric Dentistry and Orthodontics
FOURTH EDITION
Giles McCracken, BDS, PhD, FDSRCPS(Glasg),
FDS(Rest Dent), PGCAP FHEA
Professor of Restorative Dentistry
School of Dental Sciences
Newcastle University/Newcastle upon Tyne Hospitals NHS Foundation Trust
Newcastle upon Tyne
United Kingdom
For additional online content visit ExpertConsult.com
Elsevier
London New York Oxford Philadelphia St Louis Sydney 2021
Copyright © 2022 by Elsevier, Ltd. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).
Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid advances
in the medical sciences, in particular, independent verication of diagnoses and drug dosages should be
made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or
contributors for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Previous editions copyrighted 2013, 2008, and 2003.
ISBN: 978-0-7020-8144-6
Content Strategist:
Publication Service Manager:
Project Manager:
Design:
Bridget Hoette
Illustrator:
Illustration Manager:
Marketing Manager:
Printed in India
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Alexandra Mortimer
Deepthi Unni
Radjan Lourde Selvanadin
GW Inc.
Narayanan Ramakrishnan
Allison Kieer
Contents
Preface, vi
Using this Book, vii
List of Contributors, xi
1 Periodontology, 1
GILES McCRACKEN and RICHARD HOLLIDAY
2 Endodontics, 48
SIMON STONE and PHILLIP TOMSON
3 Conservative Dentistry, 86
SIMON STONE and OLIVER SAMUEL BAILEY
4 Prosthodontics, 115
JANICE ELLIS and IAN ELLIS
5 Restorative Management of Dental
Implants, 139
FRANCIS NOHL
6 Conscious Sedation in Dentistry, 148
NIGEL DOUGLAS ROBB
7 Paediatric Dentistry I, 168
ALISON CAIRNS and JILLIAN PHILLIPS
8 Paediatric Dentistry II, 193
ALISON CAIRNS and CATHERINE McCANN
9 Orthodontics I: Development, Assessment
and Treatment Planning, 217
DECLAN MILLETT
10 Orthodontics II: Management of Occlusal
Problems, 249
DECLAN MILLETT
11 Orthodontics III: Appliances and Tooth
Movement, 285
DECLAN MILLETT
12 Professionalism, Law and Ethics, 305
HEIDI BATEMAN and DOUGLAS LOVELOCK
Index, 334
v
Preface
The philosophy behind this textbook remains unchanged
from that of my predecessor editor Peter Heasman and the
chapter authors of all three editions. The emphasis remains
on supporting the reader’s understanding, learning and
self-assessment so that they are able to explore their own
level of knowledge, identify their strengths and, perhaps
more importantly, weaknesses or gaps in their knowledge
base, which can then be addressed. Basically, this book
comprises 12 chapters on key aspects of restorative dentistry, sedation, paediatric dentistry, orthodontics and professionalism.
Feedback from undergraduate dental students continues
to confirm that they value the structure of the book, especially the sections on assessment. The popularity of various
assessment methods, however, continues to change on a
regular basis and those assessment methods presented
in this textbook have been reviewed to ensure that they
remain in touch with contemporary education philosophy.
This edition has ‘single best answer’ format questions introduced in most chapters.
I should like to record my sincere thanks to Peter who
brought me in as a chapter author initially and suggested I
step forward as editor. The foundations of this book are
strong, I hope that the modifications and additions to the
work of you and the previous chapter authors adds further
value to our readers.
I am grateful and thank my colleagues Dr Hawa Fathi
and Mr Khaleel Shazada for sharing and discussing their
knowledge and insights into Equality, Diversity and Inclusion in education, the wider world and how it relates to the
themes and topics in this book.
Finally, I am deeply indebted to the hard work, patience
and talents of the contributing authors. They are experts in
their respective specialties and have worked diligently to
revise and update this fourth edition of Master Dentistry
Volume 2. Thank you all!
GIM
Newcastle-upon-Tyne
2020
vi
Using This Book
Philosophy of the Book
Most students need a textbook that will provide all the basic
facts within a discipline and that also facilitates understanding of the subject. This textbook achieves these objectives
and also provides test questions for the student to explore
their level of knowledge. It is also important for students to
achieve a ‘feel for the subject’ and learn communication
skills.
The book is designed to provide basic information necessary to pass an undergraduate examination in restorative,
paediatric and orthodontic dentistry. It also expands on the
core curriculum to allow the motivated student an opportunity to pursue the subject in greater detail. The information
is presented in such a way as to aid recall for examination
purposes and also to facilitate understanding of the subject.
Key facts are highlighted, and principles of diagnosis and
management emphasised. It is hoped that the book will also
be a satisfactory basis for postgraduate practice and studies.
Do not think though that this book offers a ‘syllabus’. It
is impossible to draw boundaries around the scientific basis
and clinical practice of dentistry. Learning is, therefore, a
continuous process carried out throughout your career.
This book includes all that you must know, most of what
you should know and some of what you might already know.
We assume that you are working towards one or more
examinations, probably in order to qualify. Our purpose is to
show you how to overcome this barrier. As we feel strongly
that learning is not simply for the purpose of passing examinations, the book aims to help you to pass but also to
develop useful knowledge and understanding.
This introductory chapter aims to help you:
n
to understand how the emphasis on self-assessment can
make learning easier and more enjoyable
n
to use this book to increase your understanding as well
as knowledge
n
to plan your learning.
LAYOUT AND CONTENTS
Each chapter begins with a brief overview of the content
and a number of learning objectives are listed at the start of
each subsection. The main part of the text in each chapter
describes important topics in major subject areas. We have
tried to provide the essential information in a logical order
with explanations and links. In order to help you, we have
used lists to set out frameworks and to make it easier for you
to put facts in a rational sequence. Tables are used to link
quite complex and more detailed information. Techniques
used in various procedures are listed in boxes.
You have to be sure that you are reaching the required
standards, so the final section of each chapter is there to
help you to check your knowledge and understanding.
The self-assessment is in the form of multiple choice
questions, extended matching items questions, case histories, short notes, data interpretation, possible viva
questions and picture questions. Questions are designed
to integrate knowledge across different chapters and to
focus on the decisions you will have to take in a given
clinical situation. Detailed answers are given with reference to relevant sections of the text; the answers also
contain information and explanations that you will not
find elsewhere, so you have to do the assessments to get
the most out of this book.
How to Use This Book
If you are using this book as part of your examination
preparations, we suggest that your first task should be to
map out on a sheet of paper three lists dividing the major
subjects (corresponding to the chapter headings) into your
strong, reasonable and weak areas. This will give you a
rough outline of your revision schedule, which you must
then fit in with the time available. Clearly, if your examinations are looming, you will have to be ruthless in the time
allocated to your strong areas. The major subjects should be
further classified into individual topics. Encouragement to
store information and to test your ongoing improvement is
by the use of the self-assessment sections – you must not
just read passively. It is important to keep checking your
current level of knowledge, both strengths and weaknesses.
This should be assessed objectively – self-rating in the
absence of testing can be misleading. You may consider
yourself strong in a particular area whereas it is more a
reflection on how much you enjoy and are stimulated by
the subject. Conversely, you may be weaker in a subject
than you would expect simply because the topic does not
appeal to you.
It is a good idea to discuss topics and problems with colleagues/friends; the areas that you understand least well
will soon become apparent when you try to explain them to
someone else.
Effective Learning
You may have wondered why an approach to learning that
was so successful in secondary school does not always work
at university. One of the key differences between your studies at school and your current learning task is that you are
now given more responsibility for setting your own learning objectives. While your aims are undoubtedly to pass
examinations, you should also aim to develop learning
skills that will serve you throughout your career. That
means taking full responsibility for self-directed learning.
The earlier you start, the more likely you are to develop the
learning skills you will need to keep up with changes in
clinical practice.
We know that students learn in all sorts of different ways,
and differ in their learning patterns at different stages in a
given course. You may intend to do as little work as you can
vii
viii
Using This Book
get away with, or you may do the least that will guarantee
to get you through the examinations; however, the students
who gain most are usually those who take a deep and sustained interest in the subject. It will be worth the effort to
start out this way, even if good intentions flag a little towards
the end.
You will also get more out of your course by participating
actively. Handouts, if given, may help, but they are rarely a
satisfactory substitute for your own lecture notes. Remember that timetabled teaching sessions are not the only opportunities for effective learning. It is safer to regard lectures, practicals and tutorials as a guide to the core material
that you are expected to master. Greater depth and breadth
to this core knowledge must be achieved by reference to
more detailed texts. Well-organised departments will provide a set of learning objectives and a reading list early in
the course. Many lecturers will give more detailed learning
objectives, either in their handouts or verbally at the start
of a lecture. If not, paragraph headings can be used as a
rough guide to the teacher’s expectations. An active approach to learning does not necessarily mean being highly
individualistic or overcompetitive. Many students gain a
broader and deeper understanding of the subject by working in small informal groups. This may be particularly helpful when it comes to revision.
The final run up to examinations should require little
more than a tying up of loose ends and a filling of learning
gaps. An effective way of doing this is to work through a
steady stream of self-assessment questions and to keep a
daily note of points that need clearing up. In other words,
concentrate on what you do not know and strengthen the
links with what you already know. By this time, the value
of pigeonholing factual information within a framework
should be self-evident.
APPROACHING THE EXAMINATIONS
The discipline of learning is closely linked to preparation for
examinations. Many of us opt for a process of superficial
learning that is directed towards retention of facts and recall under examination conditions because full understanding is often not required. It is much better if you try to acquire a deeper knowledge and understanding, combining
the necessity of passing examinations with longer-term
needs, particularly with the prospect of continuing professional development after qualification.
First you need to know how you will be examined. Does
the examination involve clinical assessment such as history
taking and clinical examination? If you are sitting a written
examination, what are the length and types of questions?
How many must you answer and how much choice will you
have?
Now you have to choose what sources you are going to
use for your learning and revision. Textbooks come in different forms. At one extreme, there is the large reference book.
This type of book should be avoided at this stage of revision
and only used (if at all) for reference, when answers to questions cannot be found in smaller books. At the other end of
the spectrum is the condensed ‘lecture note’ format, which
often relies heavily on lists. Facts of this nature on their
own are difficult to remember if they are not supported by
understanding. In the middle of the range are the mediumsized textbooks. These are often valuable irrespective of
whether you are approaching final university examinations
or the first part of professional examinations. Our advice is
to choose one of the several medium-sized books on offer on
the basis of which you find the most readable. The best
approach is to combine your lecture notes, textbooks (appropriate to the level of study) and past examination papers
as a framework for your preparation.
Armed with information about the format of the examinations, a rough syllabus, your own lecture notes and some
books that you feel comfortable in using, your next step is to
map out the time available for preparation. You must be
realistic, allow time for breaks and work steadily, not cramming. If you do attempt to cram, you have to realise that
only a certain amount of information can be retained in
your short-term memory. Cramming simply retains facts. If
the examination requires understanding, you will undoubtedly have problems.
It is often a good idea to begin by outlining the topics to
be covered and then attempting to summarise your knowledge about each in note form. In this way, your existing
knowledge will be activated and any gaps will become apparent. Self-assessment also helps to determine the time to
be allocated to each subject for examination preparation. If
you are consistently scoring excellent marks in a particular
subject, it is not very effective to spend a lot of time trying
to achieve the ‘perfect’ mark.
In an essay, it is many times easier to obtain the first 50%
of the marks than the last. You should also try to decide on
the amount of time to assign to each subject based on the
likelihood of it appearing in the examination.
THE MAIN TYPES OF EXAMINATION
Multiple Choice Questions
Most multiple choice questions test recall of information.
The aim is to gain the maximum marks from what you
can remember. The common form consists of a stem with
several different phrases that complete the statement.
Each statement is to be considered in isolation from the
rest and you have to decide whether it is ‘True’ or ‘False’.
There is no need for ‘Trues’ and ‘Falses’ to balance out for
statements based on the same stem; they may all be ‘True’
or all ‘False’. The stem must be read with great care and,
if it is long with several lines of text or data, you should try
and summarise it by extracting the essential elements.
Make sure you look out for the ‘little’ words in the stem
such as only, rarely, usually, never and always. Negatives
such as not, unusual and unsuccessful often cause marks to
be lost. May occur has entirely different connotations to
characteristic. The latter generally indicates a feature that
is normally observed, the absence of which would represent an exception to a general rule, e.g. regular elections
are a characteristic of a democratic society. Regular (if
dubious) elections may occur in a dictatorship but they
are not characteristic.
Remember to check the marking method before starting. Some still employ a negative system in which marks
are lost for incorrect answers. The temptation is to adopt