Periodontics and Implantology
Periodontics and implantology tests diagnosis by staging and grading, nonsurgical and surgical therapy, implant site assessment, and long-term maintenance. The exam expects risk-based decisions, not just pocket depths.
Core rules
- Periodontitis is staged by severity and complexity (I–IV) and graded by progression risk (A–C), incorporating bone loss, probing depths, smoking, and diabetes.
- Initial therapy is cause-related: hygiene instruction, scaling and root planing, risk-factor control, and re-evaluation at 6–8 weeks. Surgery is considered only after response is assessed.
- Peri-implant mucositis is reversible inflammation without bone loss; peri-implantitis adds progressive bone loss and requires diagnosis before treatment.
- Implant planning considers bone volume, keratinized tissue, occlusal load, medical status, and the restorative plan. Uncontrolled periodontitis and smoking increase failure risk.
- Maintenance intervals are based on risk; supportive periodontal therapy is part of treatment, not an optional extra.
Worked example
A 52-year-old smoker has 6 mm pockets, 40% bone loss, and HbA1c 8.5%. Stage III grade C is appropriate. The first phase is nonsurgical therapy, smoking cessation, and diabetes coordination; re-evaluate before proposing surgery or implants. Placing an implant now would ignore modifiable risk.
Traps
- Using probing depth alone to stage disease.
- Confusing staging (current severity) with grading (progression risk).
- Treating peri-implantitis as mucositis.
- Omitting maintenance from the treatment plan.