Periodontics
Periodontics tests how you translate periodontal charting into a diagnosis, then a treatment plan, then a maintenance interval. The 2018 World Workshop classification, the limits of adjunctive antibiotics, regenerative indications and implant health dominate the high-yield material.
Examination and classification
- Record probing depth, recession, clinical attachment level, bleeding on probing, mobility and furcation involvement; attachment level is probing depth plus recession.
- Stage I to IV is severity and complexity: attachment loss, radiographic bone loss, teeth lost to periodontitis, probing depth, furcation and ridge defects.
- Grade A to C estimates progression using the ratio of percentage bone loss to age, plus smoking and HbA1c. Ratio above 1.0, smoking 10 or more cigarettes daily, or HbA1c of 7% or more marks Grade C.
Non-surgical therapy
- Oral hygiene instruction plus scaling and root surface debridement is the foundation; re-evaluate 6-8 weeks later before deciding on surgery.
- Systemic antibiotics such as amoxicillin 500 mg with metronidazole 400 mg three times daily for seven days are adjuncts reserved for progressive or Grade C disease, never a substitute for debridement.
- Control modifiable risk factors: smoking cessation and glycaemic control change the prognosis more than any single instrument does.
Surgical and regenerative care
- Regeneration with a barrier membrane, bone graft or enamel matrix derivative works best in deep intrabony defects and Class II furcations with good plaque control.
- Mucogingival recession: the connective tissue graft is the reference standard for root coverage.
- Peri-implant mucositis is reversible with debridement and biofilm control; peri-implantitis adds progressive bone loss and often needs surgical access plus implant surface decontamination.
Worked example
A 45-year-old smoker of 15 cigarettes daily has a worst probing depth of 6 mm, 5 mm of attachment loss, three teeth lost to periodontitis and 40% bone loss at the worst site. Bone-loss-to-age ratio is 0.89, which alone would be Grade B, but the smoking habit upgrades the diagnosis to Stage III Grade C, prompting debridement, hygiene instruction, cessation advice and possibly adjunctive systemic antibiotics.
Traps
- Forgetting to add recession when calculating attachment loss, which downgrades the stage.
- Staging without considering tooth loss from periodontitis.
- Prescribing antibiotics as monotherapy.