ABP Maintenance Protocols 3 — Questions and Answers
Question 1: Which of the following local risk factors most significantly compromises periodontal maintenance outcomes?
- Shallow gingival sulci
- Furcation involvements class II or III (Correct answer)
- Supracrestal fiber attachment
- Attached gingiva width >3 mm
Correct answer: Furcation involvements class II or III
Class II or III furcation involvements harbor biofilm that is difficult to instrument, making them major local risk factors for maintenance failure.
Question 2: The Periodontal Risk Assessment (PRA) model developed by Lang and Tonetti uses which parameter to stratify maintenance patients into risk categories?
- Attachment loss rate, bleeding on probing %, environmental/systemic factors (Correct answer)
- Plaque index only
- Radiographic bone loss alone
- Pocket depth distribution
Correct answer: Attachment loss rate, bleeding on probing %, environmental/systemic factors
The PRA model integrates rate of attachment loss, percentage of bleeding on probing, number of residual pockets, bone loss/age ratio, systemic factors, and smoking to determine risk.
Question 3: A maintenance patient who smokes is LEAST likely to show which of the following clinical signs compared to a non-smoker with equivalent disease?
- Increased attachment loss
- Bone loss on radiographs
- Bleeding on probing (Correct answer)
- Deep residual pockets
Correct answer: Bleeding on probing
Smoking causes vasoconstriction that masks gingival bleeding, so smokers show less bleeding on probing despite active disease.
Question 4: Chemotherapeutic adjuncts such as locally delivered doxycycline (Atridox) during maintenance are MOST appropriately used in:
- All sites with probing depth ≥3 mm
- Isolated, non-responsive pockets ≥5 mm with active disease (Correct answer)
- Sites with only supragingival calculus
- Every maintenance patient regardless of disease status
Correct answer: Isolated, non-responsive pockets ≥5 mm with active disease
Locally delivered antibiotics are best reserved for isolated non-responding pockets ≥5 mm showing signs of active disease during maintenance.
Question 5: Which of the following best characterizes 'supportive periodontal therapy' (SPT) as distinct from standard prophylaxis?
- SPT includes full-mouth periodontal debridement and individualized risk assessment (Correct answer)
- SPT consists only of polishing and fluoride application
- SPT is performed exclusively by periodontists
- SPT replaces the need for active therapy
Correct answer: SPT includes full-mouth periodontal debridement and individualized risk assessment
SPT involves comprehensive periodontal assessment, individualized risk evaluation, and subgingival debridement as needed—far beyond a routine prophylaxis.
Question 6: How does patient compliance with the prescribed maintenance interval affect long-term tooth retention?
- Compliance has no measurable effect on tooth loss rates
- Compliant patients experience significantly lower tooth loss rates than erratic attenders (Correct answer)
- Erratic attenders lose fewer teeth because they receive more intensive treatment
- Compliance matters only in the first year after active therapy
Correct answer: Compliant patients experience significantly lower tooth loss rates than erratic attenders
Multiple longitudinal studies demonstrate that compliant maintenance patients retain significantly more teeth over time compared to erratic or non-compliant patients.
Question 7: Which radiographic finding during a maintenance visit would most urgently prompt re-evaluation for additional active therapy?
- Stable bone level compared to previous radiographs
- Lamina dura intact around all teeth
- Progressive crestal bone loss at one or more sites since the last radiograph (Correct answer)
- Slight widening of the periodontal ligament space without bone loss
Correct answer: Progressive crestal bone loss at one or more sites since the last radiograph
Progressive crestal bone loss on serial radiographs indicates active disease progression and is a clear indication to re-enter active periodontal therapy.
ABP Maintenance Protocols 3
Which of the following local risk factors most significantly compromises periodontal maintenance outcomes?