Periodontics and Implantology
What this domain tests
Periodontics and implantology test the 2018 classification, risk-based treatment planning, non-surgical and surgical therapy, and the distinction between peri-implant health, mucositis, and peri-implantitis.
Core rules
- Record probing depth, clinical attachment loss, bleeding on probing, plaque, recession, mobility, and furcation involvement for every sextant.
- Staging uses attachment loss and complexity: stage III includes CAL of 5 mm or more, probing depths of 6 mm or more, vertical defects of 3 mm or more, furcation II/III, and mobility grade 2.
- Grading uses progression risk: bone loss divided by age, smoking, and glycaemic control. HbA1c of 7% or above and smoking of 10 or more cigarettes daily raise the grade.
- Non-surgical therapy is oral hygiene instruction plus scaling and root planing, re-evaluated at 6-8 weeks; adjuncts never replace debridement.
- Systemic antibiotics are reserved for necrotising disease, abscess with systemic involvement, and selected aggressive cases; amoxicillin with metronidazole is the common combination.
- Peri-implant mucositis shows bleeding with no bone loss; peri-implantitis shows bleeding plus progressive bone loss.
- Maintenance intervals follow risk, not a fixed six months.
Worked example
A 52-year-old has 8-mm pockets on 16, a 4-mm intrabony defect, CAL 6 mm, HbA1c 8.6%, and smokes 20 cigarettes daily. Reasoning: stage III from CAL and complexity; grade C from HbA1c and heavy smoking. Plan hygiene instruction, scaling and root planing, medical referral for glycaemic control, and re-evaluation at 8 weeks before considering regenerative surgery.
Traps
Confusing pocket depth with attachment loss; diagnosing peri-implantitis without bone loss; prescribing antibiotics as a substitute for debridement.