ABP Treatment Planning 3 — Questions and Answers
Question 1: A patient presents with localized aggressive periodontitis (Stage III Grade C, molar-incisor pattern). Which adjunctive therapy is most supported by evidence?
- Topical chlorhexidine chips alone
- Systemic amoxicillin plus metronidazole combined with SRP (Correct answer)
- Systemic doxycycline monotherapy for 6 months
- Local delivery minocycline without SRP
Correct answer: Systemic amoxicillin plus metronidazole combined with SRP
Combining systemic amoxicillin (500mg TID) and metronidazole (500mg TID) with SRP has the strongest evidence for Grade C molar-incisor pattern periodontitis due to Aggregatibacter actinomycetemcomitans.
Question 2: Which classification system, adopted by the 2017 World Workshop, is currently used to classify periodontal diseases for treatment planning?
- 1989 AAP classification with Type I-IV categories
- 2017 staging and grading system (Stage I-IV, Grade A-C) (Correct answer)
- 1999 AAP classification with chronic/aggressive categories
- Page and Schroeder 1982 lesion classification
Correct answer: 2017 staging and grading system (Stage I-IV, Grade A-C)
The 2017 World Workshop classification replaced prior systems, using a staging (I-IV) and grading (A-C) framework that incorporates complexity factors and risk modifiers.
Question 3: A patient with end-stage renal disease on dialysis requires periodontal treatment. Which planning consideration is most critical?
- Avoiding all local anesthetics
- Coordinating treatment on non-dialysis days and checking drug dosing due to altered clearance (Correct answer)
- Performing all surgery within the first dialysis session
- Using only topical antimicrobials due to kidney toxicity
Correct answer: Coordinating treatment on non-dialysis days and checking drug dosing due to altered clearance
Renal patients have altered drug clearance and bleeding tendencies (post-dialysis heparin effect), so treatment is best scheduled the day after dialysis with appropriate drug dosing adjustments.
Question 4: In treatment planning for a patient with gingival enlargement due to amlodipine (a calcium channel blocker), what is the first recommended step?
- Immediate gingivectomy
- Consult with the prescribing physician about substituting the medication (Correct answer)
- Begin systemic antibiotic therapy
- Perform osseous surgery to reduce pocket depths
Correct answer: Consult with the prescribing physician about substituting the medication
Drug substitution (e.g., changing to another antihypertensive) combined with meticulous plaque control can lead to significant regression of drug-influenced gingival enlargement before considering surgery.
Question 5: When evaluating a patient for periodontal implant therapy, which factor represents an absolute contraindication to implant placement?
- Age over 65 years
- Controlled hypertension
- Active head and neck radiation therapy field (Correct answer)
- Mild periodontal bone loss at adjacent teeth
Correct answer: Active head and neck radiation therapy field
Active irradiation of the jaw is an absolute contraindication due to severely compromised vascularity and high risk of osteoradionecrosis following implant placement.
Question 6: The McGuire and Nunn prognosis classification assigns which prognosis to a tooth that is 'impossible to maintain'?
- Fair
- Poor
- Questionable
- Hopeless (Correct answer)
Correct answer: Hopeless
The McGuire and Nunn system uses 'Hopeless' for teeth that cannot be maintained due to severe bone loss, poor crown-to-root ratio, or unresolvable furcation involvement.
Question 7: A patient with Stage IV Grade C periodontitis requires full-mouth rehabilitation. What is the recommended sequence for prosthodontic and periodontal therapy?
- Place final restorations first to guide tissue contours
- Complete periodontal therapy and confirm stability before final prosthetics (Correct answer)
- Fabricate interim prosthetics while performing SRP simultaneously
- Extract all teeth and place implants before any periodontal therapy
Correct answer: Complete periodontal therapy and confirm stability before final prosthetics
Final prosthetic restorations should only be placed after periodontal health is established and stable, as tissue dimensions change during healing and affect margins and emergence profiles.
ABP Treatment Planning 3
A patient presents with localized aggressive periodontitis (Stage III Grade C, molar-incisor pattern).
Which adjunctive therapy is most supported by evidence?