Periodontics

A 46-year-old smoker (10/day) presents with generalized 4–6 mm pockets and radiographic horizontal bone loss; interdental CAL averages 3–4 mm; no tooth loss due to periodontitis.

A 55-year-old with uncontrolled diabetes (HbA1c 9.1%) has generalized 6–8 mm pockets, vertical defects, and mobility; three molars lost to periodontitis.

A 28-year-old with localized 7–8 mm pockets on first molars and incisors, arc-shaped RBL, minimal plaque; family history positive.

After quadrant SRP, when should you schedule the periodontal re-evaluation?

A mandibular molar shows Class II furcation (Hamp) on buccal aspect with 6 mm pocket; three-wall vertical defect mesial.

A patient on 70 mg weekly alendronate requires osseous resective surgery for crown lengthening of a molar.

A 34-year-old pregnant (2nd trimester) patient presents with bleeding gingiva and edematous papillae; probing ≤3 mm; no RBL.

A tooth with 8 mm pocket and primary endo–perio lesion of pulpal origin (non-vital pulp).

A 43-year-old with 5–6 mm generalized pockets after initial SRP shows persistent bleeding sites.

Crown lengthening is planned around a premolar with subgingival caries extending 1 mm into biologic width.

A 57-year-old presents with acute periodontal abscess on a vital tooth, 10 mm pocket, localized swelling, and pain; afebrile.

A 26-year-old with recession 3 mm on mandibular canine; interdental attachment intact; thick biotype desired.

A 48-year-old with keratinized gingiva width 0.5 mm around an implant and persistent mucositis.

A 50-year-old with generalized moderate periodontitis asks about maintenance.

A 35-year-old with 2-wall vertical defect (crater) between molars seeks regenerative therapy.

A 61-year-old bruxer with fremitus and widened PDL has physiologic mobility increased; plaque controlled.

A 29-year-old HIV+ patient (undetectable viral load) presents with linear gingival erythema unresponsive to routine prophylaxis.

A maxillary molar shows Class III furcation involvement with poor access and recurrent abscesses.

A 52-year-old with persistent 6–7 mm pockets in posterior segments after good SRP and OHI.

A 40-year-old with generalized bleeding on probing and visible plaque but probing depths ≤3 mm.

A 58-year-old with peri-implant mucositis (bleeding, no bone loss) requests management.

A 62-year-old with peri-implantitis shows 6–8 mm pocket and crater-like bone loss.

A 47-year-old heavy smoker (>20/day) with generalized 6 mm pockets asks about prognosis.

A 33-year-old presents with acute necrotizing ulcerative gingivitis (NUG): pain, interdental crater ulcers, fetor oris.

A 51-year-old desires root coverage for maxillary canine recession with interproximal CAL present.

Post-SRP, which factor most strongly predicts tooth loss over time?

A 59-year-old has gingival enlargement on nifedipine; hygiene fair.

A 45-year-old with tooth mobility Grade II, fremitus, and secondary occlusal trauma in a periodontitis patient.

A 36-year-old asks about systemic antibiotics for chronic periodontitis after SRP.

A 50-year-old presents with mucogingival defect: 1 mm keratinized tissue on mandibular incisor, recurrent inflammation despite good SRP.

During periodontal surgery planning, the clinician must avoid violating supracrestal tissue attachment. Approximate dimension to respect?

A 44-year-old non-smoker with localized 7 mm intrabony three-wall defect distal to #36 after SRP.

A 60-year-old on 81 mg aspirin daily needs periodontal surgery.

A molar with combined periodontal-endodontic lesion of periodontal origin (vital pulp) shows deep narrow defect and mobility.

A 52-year-old with halitosis and tongue coating; periodontal probing normal, minimal plaque.

A 39-year-old with thin periodontal phenotype needs restorative margin near the gingiva.

A 55-year-old with peri-implantitis asks about decontamination method.

A 42-year-old exhibits gingival clefting and recession from aggressive horizontal brushing.

A 49-year-old with generalized Stage III periodontitis completed SRP and site-specific surgery; what maintenance interval initially?

A patient asks why her deep infrabony defects can be regenerated but flat horizontal loss cannot.

A 62-year-old with generalized Stage III periodontitis completed SRP; residual 6–7 mm intrabony pocket distal to #36 remains.

A 45-year-old reports tooth mobility and fremitus; probing ≤3 mm, no CAL, widened PDL in molars.

A 33-year-old with localized Class II mandibular buccal furcation on #46 asks about predictability.

A 52-year-old smoker (15/day) presents with peri-implantitis: 7 mm pocket, bleeding/suppuration, crater bone loss.

A 28-year-old has localized 7–8 mm pockets on first molars/incisors, minimal plaque, positive family history.

A 57-year-old with HbA1c 8.8% seeks periodontal surgery.

A 40-year-old has 5 mm pockets on posterior teeth after SRP; persistent BOP at isolated sites.

A 36-year-old presents with 3 mm mandibular canine recession, thin phenotype, adequate KT, esthetic concern.

A tooth with combined endo–perio lesion has non-vital pulp and deep probing.

After SRP, when to reassess probing to decide next steps?

A 60-year-old on low-dose aspirin (81 mg) needs flap surgery.

A 42-year-old with generalized gingival enlargement on cyclosporine.

Anterior esthetic crown lengthening planned for excessive gingival display; biologic width encroached.

A 34-year-old with halitosis, normal probing, heavy tongue coating.

A 51-year-old implant crown shows persistent bleeding on probing; radiograph normal; cement-retained.

A 29-year-old with frenulum pull on mandibular midline and shallow vestibule has persistent recession risk.

A 58-year-old partially edentulous patient has 7 mm pockets with angular defects adjacent to tilted molars.

A 47-year-old with persistent sensitivity after SRP; exposed root surfaces in premolars.

A 61-year-old asks about host modulation therapy.

A 39-year-old has maxillary molar with Class III furcation and recurrent abscesses.

A 55-year-old on apixaban BID needs periodontal flap surgery.

A 50-year-old maintenance patient shows new localized 5 mm pocket with BOP at #26; rest of mouth is stable.

A 42-year-old requests gingival depigmentation for melanin hyperpigmentation; phenotype thick, healthy.

A 48-year-old with generalized 3–4 mm pockets and heavy calculus refuses anesthesia for SRP.

A 59-year-old asks if water flossers replace interdental brushes.

A 35-year-old presents with acute herpetic gingivostomatitis.

A 70-year-old on oral alendronate requests extraction of a hopeless tooth vs periodontal surgery.

A 46-year-old has gummy smile due to altered passive eruption; CEJs are coronal to crest.

A 43-year-old with peri-implantitis has rough, contaminated threads.

A 54-year-old with Stage II, Grade B periodontitis asks about recall.

A 31-year-old athlete presents with localized recession RT1 on #23 and high muscle pull; adequate KT absent.

A patient with untreated periodontitis requests immediate implant after molar extraction with furcation involvement.

A 50-year-old reports persistent bleeding despite good hygiene; medications include phenytoin.

A 58-year-old with multiple 6–7 mm pockets after SRP and excellent OHI asks about laser-only treatment.

A 37-year-old has papilla loss (“black triangle”) between #11–12; probing ≤3 mm; contact point 7 mm from crest.

A 62-year-old maintenance patient shows 2 mm peri-implant radiographic bone loss and 6 mm pockets with BOP/suppuration.

A 44-year-old with generalized recession complains of sensitivity; no caries.

A 56-year-old asks if chlorhexidine can replace brushing during maintenance.

A 41-year-old with generalized 4–5 mm pockets wants to know prognosis with smoking cessation.

A 35-year-old has acute periodontal abscess on a vital tooth with calculus; afebrile.

A 52-year-old non-smoker with generalized 4–5 mm pockets after SRP still has isolated bleeding sites in molars; OHI is excellent; prefers to avoid surgery.

A 44-year-old with 8 mm intrabony defect (three-wall) distal to #26 asks about outcomes.

A 60-year-old with generalized Stage III periodontitis is an ex-smoker (quit 1 year ago). What recall interval initially?

A 36-year-old with Cairo RT3 recession on #11 (loss of interproximal attachment) requests full root coverage.

During crown lengthening planning for #34, the future margin will be placed 1 mm from the bone crest.

A 48-year-old has persistent mobility and fremitus after inflammation control; patient reports discomfort when chewing.

A 55-year-old with titanium implant crown presents with peri-implant mucositis (BOP, no bone loss).

A 29-year-old with necrotizing periodontitis (NUP) has pain, rapid attachment loss, and halitosis; HIV positive with low CD4.

A 63-year-old on denosumab for osteoporosis requires extraction of a hopeless molar; patient asks about MRONJ risk.

A patient with a prosthetic heart valve needs quadrant SRP.

A 41-year-old with mandibular Class II furcation (buccal) asks about long-term prognosis.

During access flap surgery, a shallow crater is found; horizontal bone loss predominates.

A 50-year-old presents with halitosis; periodontal charting stable; tonsillar crypts with tonsilloliths noted.

A 34-year-old with thin tissue phenotype needs subgingival margin in esthetic zone.

A patient asks whether water flosser can replace interdental brushes around posterior embrasures.

A 38-year-old with Stage II, Grade B periodontitis has persistent 6 mm pocket with root concavity.

A 47-year-old diabetic (HbA1c 6.9%) with peri-implantitis (7 mm pocket, crater defect) asks about therapy.

A 23-year-old presents with altered passive eruption and excessive gingival display; CEJ near incisal edges; crest coronal to CEJ.

A maxillary molar with Class III furcation and recurrent suppuration is splinted to adjacent teeth.

A 59-year-old maintenance patient shows new 5 mm pocket with suppuration at #16 mesiobuccal; rest of mouth stable.

A 45-year-old with bruxism and generalized recession complains of sensitivity.

A 62-year-old on apixaban presents for open-flap debridement.

A 50-year-old with localized 7 mm pocket distal to #37 and distal wedge tissue impinging hygiene.

A 33-year-old complains of “black triangles” after ortho; contact point is 6.5 mm from crest.

A 58-year-old with mandibular anterior mucogingival problem: 0 mm keratinized tissue, persistent inflammation despite hygiene.

A 42-year-old with gingival enlargement on nifedipine requests surgery immediately.

A 39-year-old with mandibular tori complains that floss cuts papillae; no periodontal disease.

A 51-year-old with peri-implantitis has rough threads exposed; you plan surface decontamination.

A 28-year-old with molar–incisor pattern periodontitis improved after SRP + amoxicillin/metronidazole; asks about maintenance.

A 57-year-old with angular defect around #46 and mesial tilting asks if orthodontic uprighting helps.

A patient asks if lasers can “replace” flap surgery for persistent 7–8 mm pockets.

A 46-year-old with generalized 5 mm pockets refuses local anesthesia for SRP.

A 70-year-old on low-dose aspirin has significant gingival bleeding during maintenance.

A 55-year-old with a history of periodontitis receives an implant; asks about risk of peri-implant disease.

A 40-year-old with localized gingival recession RT1 on #23 and high frenum pull.

A 59-year-old with generalized Stage IV periodontitis completed therapy; multiple missing posterior teeth and drifting.

A 53-year-old with peri-implantitis asks about systemic antibiotics alone to avoid surgery.

A 32-year-old with pregnancy gingivitis (2nd trimester) asks about safety of care.

A 48-year-old asks why one posterior site keeps inflaming despite “good brushing.” Interdental space is open with concavity.

A 45-year-old smoker (15/day) after SRP shows residual 7 mm pockets with BOP in mandibular molars.