Clinical Periodontology and Implantology
What the exam tests
Clinical Periodontology and Implantology tests whether you can classify disease, control risk factors, plan cause-related treatment, and decide when surgery or an implant is defensible. Questions often hinge on the 2017 World Workshop classification, peri-implant definitions, and maintenance.
Core rules
- Stage periodontitis using the worst site: interdental clinical attachment loss (CAL), radiographic bone loss, and tooth loss attributable to periodontitis. Pocket depth alone does not stage disease.
- Stage I: CAL 1–2 mm; Stage II: CAL 3–4 mm; Stage III: CAL ≥5 mm with bone loss to the middle third and ≤4 teeth lost; Stage IV adds masticatory dysfunction, bite collapse, drifting, or <20 teeth.
- Extent is localized (<30% of teeth) or generalized (≥30%).
- Grade predicts progression: radiographic bone loss divided by age. Grade B is 0.25–1.0; Grade C is >1.0. Smoking ≥10 cigarettes/day or HbA1c ≥7.0% shifts an otherwise B case to C.
- Peri-implant health has no bleeding on probing (BOP), swelling, or progressive bone loss. Mucositis has BOP or suppuration without progressive loss. Peri-implantitis adds progressive bone loss beyond initial remodeling; pocket depth supports but does not confirm the diagnosis.
- Re-evaluate non-surgical therapy at 6–8 weeks before deciding on surgery.
Worked example
A 52-year-old smoker (15/day) with HbA1c 8.0% has a 7 mm pocket and 6 mm CAL at 16, with 50% bone loss. Stage: CAL ≥5 mm and bone loss to the middle third, so Stage III. Grade: 50/52 ≈ 0.96, nominally B, but heavy smoking and HbA1c ≥7.0% upshift to C. If more than 30% of teeth are affected, it is generalized Stage III Grade C. The immediate plan is risk-factor counselling, oral hygiene instruction, subgingival instrumentation, and re-evaluation, not implants.
Traps
- Staging from pocket depth instead of CAL.
- Forgetting the grade upshift for smoking or diabetes.
- Calling peri-implantitis from a deep pocket alone.
- Placing implants before periodontal stability.