ABP Non-Surgical Therapy 3 — Questions and Answers
Question 1: Which of the following best describes the rationale for the 4–8 week re-evaluation interval after completion of SRP?
- To allow complete regeneration of lost bone
- To allow tissue healing and resolution of inflammation before reassessing residual disease (Correct answer)
- To wait for antibiotic therapy to complete its full systemic effect
- To schedule the next SRP appointment immediately
Correct answer: To allow tissue healing and resolution of inflammation before reassessing residual disease
A 4–8 week interval allows sufficient time for tissue healing, resolution of edema, and reduction of probing depths before reassessing the need for further therapy.
Question 2: Minocycline microspheres (Arestin) are classified as what type of delivery system when used as an adjunct to SRP?
- Systemic sustained-release antibiotic
- Local sustained-release antibiotic (Correct answer)
- Antiseptic irrigation solution
- Enzyme-suppression therapy
Correct answer: Local sustained-release antibiotic
Arestin delivers minocycline locally into the periodontal pocket via bioresorbable microspheres, achieving high local concentrations while minimizing systemic exposure.
Question 3: A patient with Stage II periodontitis has residual pockets of 4–5 mm at re-evaluation after SRP. According to current guidelines, the most appropriate next step is:
- Immediate periodontal surgery
- Re-instrumentation of residual pockets and continued supportive care (Correct answer)
- Extraction of all involved teeth
- Systemic antibiotic course without further SRP
Correct answer: Re-instrumentation of residual pockets and continued supportive care
Residual 4–5 mm pockets after SRP may respond to re-instrumentation and optimization of risk factors before surgical intervention is considered.
Question 4: Which of the following best explains why powered (ultrasonic) scalers can be equally effective as hand instruments for SRP?
- They generate heat that sterilizes the pocket
- Cavitation and acoustic microstreaming disrupt biofilm in addition to mechanical removal (Correct answer)
- They remove more tooth structure, ensuring cleaner surfaces
- They are more effective only in shallow pockets
Correct answer: Cavitation and acoustic microstreaming disrupt biofilm in addition to mechanical removal
Ultrasonic scalers produce cavitation and acoustic microstreaming effects that disrupt and flush the subgingival biofilm, complementing mechanical debridement.
Question 5: Sub-antimicrobial dose doxycycline (SDD, Periostat 20 mg BID) exerts its periodontal benefit primarily through which mechanism?
- Direct bactericidal action against periodontopathogens
- Inhibition of host-derived matrix metalloproteinases (MMPs) (Correct answer)
- Enhancement of osteoblast activity
- Reduction of salivary IgA levels
Correct answer: Inhibition of host-derived matrix metalloproteinases (MMPs)
SDD at 20 mg BID does not reach bactericidal levels but suppresses host-derived MMPs (collagenase), thereby reducing collagen breakdown and attachment loss.
Question 6: Which periodontal pathogen is considered the primary exogenous pathogen ('red complex' species) most strongly linked to deep, refractory periodontal pockets?
- Aggregatibacter actinomycetemcomitans
- Treponema denticola
- Porphyromonas gingivalis (Correct answer)
- Fusobacterium nucleatum
Correct answer: Porphyromonas gingivalis
Porphyromonas gingivalis is a keystone red-complex pathogen that produces virulence factors disrupting host immunity and is most strongly associated with severe periodontitis.
Question 7: When using ultrasonic instrumentation on a patient with a cardiac pacemaker, what is the current AHA/AAP guidance?
- Ultrasonic scalers are absolutely contraindicated in all pacemaker patients
- Consult with the patient's cardiologist; modern pacemakers are generally shielded from ultrasonic interference (Correct answer)
- Only magnetostrictive units are safe; piezoelectric units are contraindicated
- Ultrasonic scalers must be used only at the lowest power setting
Correct answer: Consult with the patient's cardiologist; modern pacemakers are generally shielded from ultrasonic interference
Modern pacemakers are shielded, but consultation with the cardiologist is recommended; older or externally worn devices may still pose a risk requiring precaution.
ABP Non-Surgical Therapy 3
Which of the following best describes the rationale for the 4–8 week re-evaluation interval after completion of SRP?