ABP Treatment Planning 2 — Questions and Answers
Question 1: A patient with Stage III Grade C periodontitis and poorly controlled Type 2 diabetes presents for treatment planning. What is the most appropriate initial step?
- Proceed directly to surgical therapy
- Establish glycemic control before initiating periodontal therapy (Correct answer)
- Extract all teeth with probing depths >6mm
- Begin systemic antibiotics without further evaluation
Correct answer: Establish glycemic control before initiating periodontal therapy
Poorly controlled diabetes impairs periodontal healing, so optimizing glycemic control (target HbA1c <7%) before active therapy improves treatment outcomes.
Question 2: Which factor most strongly predicts tooth loss after periodontal treatment when formulating a long-term prognosis?
- Tooth mobility at baseline
- Patient compliance with supportive periodontal therapy (Correct answer)
- Initial probing depth
- Radiographic bone loss pattern
Correct answer: Patient compliance with supportive periodontal therapy
Long-term studies consistently show patient compliance with supportive periodontal therapy is the single strongest predictor of tooth retention after active treatment.
Question 3: When planning treatment for a patient with a furcation Class III molar, which option offers the most predictable long-term outcome?
- Tunnel preparation
- Root resection with endodontic therapy
- Guided tissue regeneration
- Extraction and implant placement (Correct answer)
Correct answer: Extraction and implant placement
Class III furcation involvement carries the poorest prognosis, and extraction followed by implant placement typically yields more predictable long-term results than heroic retention attempts.
Question 4: In a patient taking bisphosphonates for osteoporosis who requires periodontal surgery, what is the primary concern?
- Increased risk of periodontal relapse
- Medication-related osteonecrosis of the jaw (MRONJ) (Correct answer)
- Excessive bleeding during surgery
- Antibiotic resistance
Correct answer: Medication-related osteonecrosis of the jaw (MRONJ)
Bisphosphonates suppress bone remodeling, and surgical trauma can trigger MRONJ, necessitating careful risk assessment and possible drug holiday for IV bisphosphonates.
Question 5: A strategic extraction is most appropriately considered when a tooth has which combination of findings?
- Probing depth 5mm with Grade A periodontitis
- Hopeless prognosis that compromises the overall treatment plan (Correct answer)
- Furcation Class I with vertical bone loss
- Mobility Grade I with controlled inflammation
Correct answer: Hopeless prognosis that compromises the overall treatment plan
Strategic extraction is justified when retaining a tooth with a hopeless prognosis would compromise adjacent teeth, prosthetic outcomes, or overall treatment success.
Question 6: Which patient scenario best justifies a 3-month supportive periodontal therapy (SPT) interval rather than a 6-month interval?
- Stage I Grade A periodontitis, full compliance, no risk factors
- Stage III Grade B periodontitis, smoker, residual pockets 4-5mm (Correct answer)
- Gingivitis only, low plaque score, no bone loss
- Post-surgical patient 3 years in remission with no recession
Correct answer: Stage III Grade B periodontitis, smoker, residual pockets 4-5mm
Higher disease stage, active risk factors like smoking, and residual pockets increase recurrence risk, warranting more frequent SPT intervals.
Question 7: When sequencing periodontal treatment, during which phase should osseous surgery typically be performed?
- Phase I (systemic phase)
- Phase II (surgical phase), after re-evaluation of Phase I outcomes (Correct answer)
- Simultaneously with initial scaling and root planing
- Only after prosthetic restorations are placed
Correct answer: Phase II (surgical phase), after re-evaluation of Phase I outcomes
Osseous surgery is performed in Phase II only after re-evaluating the tissue response to Phase I (non-surgical) therapy, ensuring inflammation is controlled first.
ABP Treatment Planning 2
A patient with Stage III Grade C periodontitis and poorly controlled Type 2 diabetes presents for treatment planning.
What is the most appropriate initial step?