Session 2 trial class
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Space = play/pause · ↑↓ = nudge · R = reset
Scene 1 — Cold Open | 0:00 – 1:00
📷 Direct to camera · Confident, measured
In Session 1
you learned the benchmark.
You learned the cluster structure.
And you learned why reasoning matters more than recall.
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Now I want to show you
what that actually looks like.
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This is the Alexander case.
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It is the only official vignette
the ADC has ever released publicly.
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Five questions.
One patient.
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And I am going to solve each one for you —
including showing you the wrong way first,
so you can see exactly what the examiner is trying to catch.
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Let me read you the case.
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Alexander is a 64-year-old patient on warfarin
for atrial fibrillation.
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One of his lower right back teeth
was restored three years ago
with a resin composite.
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It is now occasionally sensitive
to hot and cold.
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You have the clinical notes.
You have obtained a periapical radiograph.
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Five questions come from this scenario.
Let us start with the first.
Scene 2 — Question 1: Percussion Test | 1:00 – 3:00
📷 Direct to camera · Instructive, analytical
Question 1 asks —
in addition to pulp vitality testing,
which is already happening —
what is the single most appropriate test
to assist in making a diagnosis?
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The options are:
OPG ... bitewing ... percussion test ...
crack test ... and INR test.
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Let me show you how most candidates approach this.
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❌ Wrong path:
They see a sensitivity complaint.
They know composites can crack.
They select the crack test.
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Or they see a radiographic question
and select the bitewing.
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Both feel reasonable.
Neither is correct.
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Here is how an examiner-aware candidate reads this question.
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The question is about making a diagnosis.
Vitality testing is already being done —
that tells you pulpal status.
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What you do not yet know is —
has the periapical region been affected?
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Is there periapical inflammation?
Is this moving from reversible
to irreversible pulpitis?
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The percussion test answers that question directly.
A positive percussion response means periapical involvement.
No other option on this list answers that.
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The OPG?
You already have a periapical.
Higher dose. Lower resolution. ARPANSA says no.
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The bitewing?
Useful for caries. Useless for periapical status.
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The INR?
That matters for treatment planning. Not for diagnosis. Wrong stage.
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The crack test?
There is nothing in this vignette pointing to a crack.
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Percussion test. C. Every time.
Scene 3 — Question 2: Gingival Margin on Dentine | 3:00 – 5:30
📷 Direct to camera · Precise, clinical
Question 2.
What is most likely to cause the failure
of the Class II composite?
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This is a material science question
embedded in the patient scenario.
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❌ Tempting wrong answer:
Option C —
occlusal loads applied to the marginal ridge
due to flexure.
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It sounds biomechanically solid.
Candidates with good clinical experience often select it.
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It is not the correct answer.
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The correct answer is E —
gingival margin on dentine,
because bonding under these conditions is unpredictable.
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Here is why.
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A Class II composite has a proximal box.
The floor of that box — the gingival seat —
sits on dentine or cementum.
Not enamel.
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Bonding to dentine is less reliable.
It is more moisture-sensitive.
And polymerisation shrinkage pulls the material away
from exactly this margin.
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The gingival margin of the proximal box
is the most predictable failure site
in a Class II composite.
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That is the documented primary failure mode.
Not flexure. Not increments. Not the lining.
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Option A — incremental placement causes leakage.
Backwards.
Incremental placement reduces shrinkage stress.
It does not cause leakage.
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Option D — extended curing causes more shrinkage.
Also backwards.
Longer curing improves conversion
and reduces residual shrinkage.
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The examiner wrote options A and D
knowing that candidates with partial knowledge
would find them plausible.
They are both factually reversed.
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Gingival margin on dentine. E.
The primary failure mode.
Scene 4 — Question 3: Dull and Lingering | 5:30 – 7:30
📷 Direct to camera · Build-up, then clear resolution
Question 3 asks you to describe the sensitivity
Alexander would most likely report
given the history and radiographic evidence.
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This is a pulpal diagnosis question.
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❌ Most popular wrong answer:
Option B —
sharp and relieved on removal of the stimulus.
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Almost every candidate has been taught
that dental sensitivity is sharp
and goes away when the stimulus is removed.
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That is the description of reversible pulpitis.
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But the question asks you to read the clinical picture.
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Three-year-old composite.
Gingival margin failure.
Ongoing microleakage.
Bacterial ingress.
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That tooth is not showing reversible pulpitis.
It is progressing toward irreversible pulpitis.
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And irreversible pulpitis has a specific pain signature:
dull ... and lingering.
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The pain persists
for one to two minutes
after you remove the stimulus.
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That is the discriminating feature.
That is what option C describes.
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Option D — always present, worse with stimulus —
describes acute pulp necrosis or abscess.
Constant pain. Not what this patient has.
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Option E — worse in the morning —
is not a recognised dental pulpal pain pattern.
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The word you are looking for in this question
is lingering.
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When you see 'dull and lingering' —
that is irreversible pulpitis.
C.
Scene 5 — Question 4: Proceed with Extraction | 7:30 – 9:30
📷 Direct to camera · Firm, evidence-based, no hesitation
Question 4.
INR is 2.4.
You have decided to extract the tooth.
What do you do?
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This is the question where candidates
most commonly refer unnecessarily.
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Option D — consult the cardiologist.
Option E — refer to an Oral and Maxillofacial Surgeon.
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Both feel like the right clinical response.
Warfarin ... atrial fibrillation ... complexity —
send it up the chain.
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That is exactly the trap.
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INR 2.4 is within the therapeutic range
for atrial fibrillation.
Therapeutic range is 2.0 to 3.0.
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The Therapeutic Guidelines — September 2025 — are explicit:
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For simple dental extractions
with INR within therapeutic range —
do not stop warfarin.
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The thromboembolic risk of stopping warfarin
in an AF patient —
stroke, systemic embolism —
is significantly greater
than the bleeding risk from a simple extraction
with local haemostatic measures.
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Option B — stop warfarin for 3 days.
Dangerous.
You are creating a sub-therapeutic window
in a high-risk cardiac patient.
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Option C — stop warfarin and start aspirin.
Doubly dangerous.
Aspirin adds antiplatelet effect
on top of reduced anticoagulation.
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Option E — OMFS referral.
A single-tooth extraction is within GP scope.
This is not a complex surgical problem.
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Proceed.
Apply haemostatic measures.
Give post-operative instructions.
A.
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The benchmark is the minimally competent
recent Australian graduate
who has read the TG.
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That graduate does not refer a simple extraction
in a patient with therapeutic INR.
Scene 6 — Question 5: Patient Autonomy | 9:30 – 11:30
📷 Warmer tone · Deliberate pace · Let the silences breathe
Question 5.
After extraction of 46,
which prosthodontic option is most appropriate?
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You already know this is the C4 question.
It is always C4 in Q5.
Professionalism and autonomy.
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The options are:
immediate implant ... immediate RPD ...
RPD after healing ... fixed bridge ...
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and —
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no replacement
until the patient has had an opportunity
to assess their own functional and aesthetic concerns.
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Most candidates select C —
RPD after healing.
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It sounds responsible.
It sounds like planning.
It sounds like good care.
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It is wrong.
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Here is the question the examiner is actually asking:
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Whose decision is it
to replace this tooth?
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The answer is Alexander's.
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Not yours.
— long pause — let it sit —
You do not know yet
whether Alexander is bothered by the gap.
You do not know whether he has aesthetic concerns.
You do not know his priorities.
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The Australian standard —
the AHPRA standard —
requires that the patient be given the opportunity
to form a view
before a replacement plan is prescribed.
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Options A through D all prescribe a treatment
before the patient has been consulted.
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Option E does not prescribe.
It waits.
It respects autonomy.
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This is the most important lesson
in the entire Alexander case.
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Q5 is never about clinical knowledge.
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It is about whether you understand
that your role is to inform,
not to decide.
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E. Every time.
Scene 7 — Close | 11:30 – 12:30
📷 Direct, calm, confident · Measured delivery
Five questions.
One case.
The same process each time.
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Identify the cluster.
Apply the Australian standard.
Find the trap.
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Choose the answer that the minimally competent
recent Australian graduate would choose —
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not the answer that feels clinically comfortable.
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You now have the methodology.
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Session 3 puts it under exam conditions.
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Twenty questions.
Thirty minutes.
No explanations until you submit.
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When you do submit,
your results will show you your performance
by cluster ... by difficulty ...
and by trap category.
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That is the first honest measure
of where you stand.
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Go to Session 3
when you are ready.