Periodontology and Implant Dentistry
This domain tests the 2018 AAP/EFP classification, periodontal risk assessment, non-surgical and surgical therapy, and the distinction between peri-implant health, mucositis and peri-implantitis.
Classification
- Staging (I to IV) uses interdental clinical attachment loss, radiographic bone loss, tooth loss attributable to periodontitis and complexity factors such as probing depth, furcation and vertical defects.
- Grading (A to C) estimates progression: ratio of percentage radiographic bone loss to age (below 0.25 is A, 0.25 to 1.0 is B, above 1.0 is C), modified by smoking and diabetes with HbA1c.
Peri-implant disease
- Peri-implant mucositis: bleeding on gentle probing, no bone loss beyond initial remodelling.
- Peri-implantitis: bleeding plus bone loss of 3 mm or more and probing depth of 6 mm or more with bleeding, per the 2018 consensus.
Therapy
- Non-surgical debridement with oral hygiene instruction first; re-evaluate at 8 to 12 weeks before any surgery.
- Adjunctive systemic amoxicillin plus metronidazole is reserved for grade C or rapidly progressing cases, always on top of mechanical therapy.
- Subantimicrobial-dose doxycycline 20 mg twice daily is host modulation, not an antibiotic course.
- Supportive periodontal therapy at 3 to 4 month intervals for treated periodontitis.
Worked example
A 45-year-old smoker has 5 mm interdental clinical attachment loss at the worst site and 30 percent radiographic bone loss, with no tooth lost to periodontitis. Staging: Stage III on attachment loss and bone loss. Grading: 30 divided by 45 equals 0.67, which falls in the 0.25 to 1.0 band, so Grade B. Plan: hygiene phase, subgingival debridement, smoking cessation, re-evaluation, then supportive care.
Traps
- Staging from pocket depth alone.
- Calling bleeding with intact bone peri-implantitis.
- Prescribing antibiotics without debridement.
- Placing implants in a patient with untreated grade C periodontitis.