Prometric Exam Questions for Periodontics Specialists 2026: 20 MCQs with Answers on the 2017 Classification, Staging and Grading, Non-surgical Therapy, Antimicrobials, Periodontal Surgery, Regeneration, Mucogingival Surgery, Peri-implant Disease and Systemic Links

The specialist periodontics paper (PER5131 at DHA, with PRI5772 for consultants, and the equivalent SCFHS, QCHP and NHRA papers) is 100 to 150 single-best-answer questions in up to three hours with a pass mark of about 60%. The Gulf's diabetes and smoking rates make periodontal disease a public health priority, and implant dentistry has made periodontists the specialists who manage the complications. The paper is anchored in the 2017 classification, evidence-based treatment sequencing and surgical decision-making. This set covers what recurs. The licensing route is in the specialist dentist guide.

Classification and diagnosis

Question 1

A 45-year-old non-smoker has interdental clinical attachment loss of 5 mm at the worst site, radiographic bone loss to the middle third of the roots, two teeth lost to periodontitis, and bone loss as a percentage of root length divided by age of about 1.2. Under the 2017 classification the diagnosis is:

1. Stage I, grade A
2. Stage III, grade C periodontitis (interdental CAL of 5 mm or more, bone loss to the middle third, up to four teeth lost; a bone loss/age ratio above 1.0 indicates rapid progression)
3. Stage II, grade B
4. Stage IV, grade A

Answer: B. Stage is severity and complexity (I to IV); grade is rate of progression and risk (A to C), modified by smoking and diabetes (HbA1c 7.0% or more moves grade to C). Extent is localised (under 30% of teeth), generalised or molar-incisor pattern.

Question 2

Which finding distinguishes periodontal health on a reduced periodontium in a successfully treated periodontitis patient from recurrent disease?

1. Any probing depth above 3 mm indicates disease
2. Probing depths of 4 mm or less with no bleeding on probing (and less than 10% bleeding sites) define health or stability on a reduced periodontium; a 4 mm site that bleeds, or any site of 5 mm or more, indicates recurrence
3. Recession alone indicates disease
4. Radiographic bone loss indicates active disease

Answer: B. Previous bone loss is a historical finding; bleeding on probing is the key indicator of current inflammation.

Question 3

A 19-year-old patient with poor oral hygiene, stress and smoking presents with painful, punched-out, necrotic interdental papillae covered by a grey pseudomembrane, halitosis and fever. The diagnosis and immediate management are:

1. Herpetic gingivostomatitis; aciclovir
2. Necrotising gingivitis; gentle superficial debridement under local anaesthesia, chlorhexidine or hydrogen peroxide rinses, systemic metronidazole if there is fever or lymphadenopathy, pain control, hygiene instruction and smoking cessation, then definitive periodontal care and assessment for underlying immunosuppression (including HIV) in severe or recurrent cases
3. Periodontal abscess; incision
4. Scaling under general anaesthesia

Answer: B. Necrotising periodontal diseases progress from gingivitis to periodontitis to stomatitis; the 2017 classification groups them by host status.

Question 4

A patient on amlodipine develops firm, lobulated gingival enlargement of the anterior papillae. The management is:

1. Immediate gingivectomy without changing anything else
2. Plaque control and non-surgical therapy, liaison with the physician about substituting the calcium channel blocker, and surgical reduction (gingivectomy or flap) if enlargement persists after three to six months of good control and drug change
3. Antibiotics
4. Stop the antihypertensive without consulting the physician

Answer: B. Phenytoin, ciclosporin and calcium channel blockers are the classic causes; plaque control reduces severity even if the drug cannot be changed.

Non-surgical therapy

Question 5

According to the European Federation of Periodontology S3 guideline, the first step of periodontal therapy includes:

1. Immediate flap surgery at all deep sites
2. Supragingival biofilm control, oral hygiene instruction and motivation, risk factor control (smoking cessation, diabetes management) and removal of plaque-retentive factors, before step two (subgingival instrumentation) and step three (surgical management of residual pockets)
3. Systemic antibiotics for all patients
4. Laser therapy as a stand-alone treatment

Answer: B. Step four is supportive periodontal care; re-evaluation is performed about 6 to 12 weeks after subgingival instrumentation.

Question 6

Which statement about full-mouth disinfection versus quadrant-wise subgingival instrumentation is correct?

1. Full-mouth disinfection within 24 hours is substantially superior
2. Both approaches produce similar clinical outcomes; the choice depends on patient and practical factors, and the addition of chlorhexidine to full-mouth protocols adds little
3. Quadrant-wise treatment must be spaced a month apart
4. Ultrasonic instruments are inferior to hand instruments

Answer: B. Hand and powered instruments are equally effective; the goal is calculus removal and biofilm disruption rather than aggressive cementum removal.

Question 7

Adjunctive systemic antibiotics in periodontitis are best reserved for:

1. Every patient with stage II periodontitis
2. Selected patients such as young adults with generalised stage III grade C (formerly aggressive) periodontitis, given with (not instead of) subgingival instrumentation, typically amoxicillin plus metronidazole for 7 days, with a careful antimicrobial stewardship rationale
3. All smokers
4. Patients who decline scaling

Answer: B. Routine use is not recommended; locally delivered antimicrobials (chlorhexidine chips, minocycline, doxycycline gel) have modest adjunctive benefit in residual pockets.

Question 8

At re-evaluation 10 weeks after subgingival instrumentation, a patient has residual 6 mm pockets with bleeding at the molars and good plaque control (under 20%). The appropriate next step is:

1. Repeat the same instrumentation indefinitely
2. Surgical access (step three): access flap, resective or regenerative surgery depending on defect morphology, because residual pockets of 6 mm or more with bleeding are unlikely to resolve with repeated non-surgical therapy and predict progression
3. Discharge the patient
4. Systemic antibiotics alone

Answer: B. Surgery is only offered to patients who have achieved adequate plaque control and have controlled risk factors.

Periodontal surgery

Question 9

A lower first molar has a 6 mm interproximal three-wall intrabony defect. The surgical approach with the best evidence for attachment gain is:

1. Gingivectomy
2. Regenerative surgery with a minimally invasive or papilla-preservation flap and enamel matrix derivative or a bone graft with or without a membrane, which gains more clinical attachment and bone than access flap alone in deep contained defects
3. Osseous resective surgery
4. Extraction

Answer: B. Narrow, deep, contained (three-wall) defects regenerate best; wide, shallow one-wall defects are better treated resectively or with access flap.

Question 10

An upper first molar has a class III (through-and-through) furcation involvement with 50% bone loss around one root. Management options include:

1. Regenerative surgery, which reliably closes class III furcations
2. Root resection or hemisection if the remaining roots are restorable and endodontically treated, tunnel preparation in selected lower molars, or extraction and implant or bridge replacement, with the decision based on the restorative and strategic value of the tooth
3. Scaling alone
4. Furcation plasty closes the defect

Answer: B. Regeneration is predictable in class II mandibular buccal furcations, not class III; retained furcation-involved molars can be maintained long term with excellent compliance.

Question 11

Surgical crown lengthening is planned for a fractured upper premolar with 2 mm of supragingival tooth structure. The biological width concept requires:

1. Placing the restoration margin at the bone crest
2. Maintaining about 2 mm of connective tissue and epithelial attachment above the bone (biological width) plus about 1 mm of sulcus, so bone is recontoured to leave approximately 3 mm between the planned restorative margin and the osseous crest, with healing of about 6 to 12 weeks (longer in the aesthetic zone) before final impressions
3. Gingivectomy alone in all cases
4. Orthodontic intrusion

Answer: B. Violating the biological width causes chronic inflammation and bone loss; where crown lengthening would leave an unfavourable crown-root ratio, orthodontic extrusion is the alternative.

Question 12

A 30-year-old has 4 mm of recession on an upper canine with no interproximal bone or attachment loss (recession type 1, Miller class I) and complains of aesthetics and sensitivity. The procedure with the most predictable complete root coverage is:

1. Free gingival graft
2. Coronally advanced flap with a subepithelial connective tissue graft, which gives the highest probability of complete root coverage and keratinised tissue gain; enamel matrix derivative or collagen matrix are alternatives to autogenous grafts with somewhat less predictable results
3. Apically repositioned flap
4. No treatment is possible

Answer: B. Cairo recession type 1 has no interproximal loss and allows full coverage; type 2 allows coverage up to the interproximal level and type 3 does not allow full coverage. Free gingival grafts increase keratinised tissue but give poor colour match.

Question 13

Which patient most needs an increase in keratinised tissue around teeth or implants?

1. Any patient with less than 5 mm of keratinised gingiva
2. A patient with persistent inflammation, discomfort during brushing or progressive recession at a site with minimal (under 2 mm) keratinised tissue, or an implant site with less than 2 mm of keratinised mucosa and plaque accumulation, particularly before orthodontic movement or restoration with subgingival margins
3. Every implant patient
4. Patients with thick gingiva

Answer: B. Health can be maintained with minimal keratinised tissue when hygiene is good; augmentation is indicated when hygiene or stability is compromised.

Implants and peri-implant disease

Question 14

According to the 2017 World Workshop, peri-implantitis is diagnosed when there is:

1. Any probing depth of 4 mm around an implant
2. Bleeding or suppuration on probing with increased probing depth compared with baseline and radiographic bone loss beyond initial remodelling; without baseline records, bone loss of 3 mm or more with probing depth of 6 mm or more and bleeding is used
3. Bone loss of 0.5 mm in the first year
4. Recession alone

Answer: B. Peri-implant mucositis is bleeding without bone loss and is reversible; a history of periodontitis, poor plaque control, smoking, residual cement and lack of maintenance are the main risk factors.

Question 15

A patient with treated stage III periodontitis wants implants. The appropriate advice is:

1. Implants are contraindicated in all periodontitis patients
2. Implants are possible once periodontitis is treated and stable, with the patient informed of a higher risk of peri-implantitis and implant loss, strict supportive care every three to four months, and residual pockets treated before placement because they act as bacterial reservoirs
3. Place implants during active disease to save time
4. Extract all teeth prophylactically

Answer: B. Implants do not get periodontitis, but peri-implantitis progresses faster than periodontitis once established.

Systemic links and special groups

Question 16

Which statement about diabetes and periodontitis is best supported by evidence?

1. Periodontitis has no effect on glycaemic control
2. The relationship is bidirectional: poorly controlled diabetes increases periodontitis severity and progression, and periodontal treatment produces a modest reduction in HbA1c (about 0.3 to 0.4 percentage points at three to four months), so periodontal care is part of diabetes management
3. Only type 1 diabetes affects the periodontium
4. Well-controlled diabetics cannot receive periodontal surgery

Answer: B. Gulf diabetes prevalence is among the highest globally, so the exam tests screening for undiagnosed diabetes in patients with unexpectedly severe periodontitis.

Question 17

A pregnant patient in the second trimester has a localised, soft, red, bleeding gingival enlargement on the interdental papilla of an upper premolar. The management is:

1. Urgent excision with biopsy
2. Diagnose a probable pregnancy epulis (pyogenic granuloma); improve plaque control, remove local irritants with careful scaling, and defer excision until after delivery unless it bleeds excessively, interferes with function or fails to regress; routine periodontal treatment is safe throughout pregnancy and best delivered in the second trimester
3. Antibiotics
4. No dental treatment until after delivery

Answer: B. Pregnancy gingivitis reflects hormonal exaggeration of the plaque response; periodontal treatment in pregnancy is safe, though evidence that it changes birth outcomes is weak.

Question 18

A smoker of 20 cigarettes a day has periodontitis. Which statement is correct?

1. Smokers bleed more on probing because of greater inflammation
2. Smoking is the major modifiable risk factor, roughly doubling to tripling risk; smokers show less bleeding and redness despite deeper pockets, respond less well to non-surgical, surgical and regenerative therapy, and have higher implant failure, so cessation support is part of step one of treatment
3. Shisha (waterpipe) use carries no periodontal risk
4. Smoking cessation does not change treatment outcomes

Answer: B. Waterpipe smoking, common in the Gulf, carries a periodontal risk comparable to cigarettes; former smokers' risk declines over about 10 years.

Question 19

A patient has a sudden painful swelling over a lower molar with a 7 mm pocket, pus on probing and a vital tooth. The diagnosis and management are:

1. Periapical abscess; root canal treatment
2. Periodontal abscess; drainage through the pocket or incision, debridement of the pocket, irrigation, occlusal relief if needed, and systemic antibiotics only with systemic involvement, followed by definitive periodontal treatment of the site
3. Pericoronitis; extraction of the molar
4. Gingival cyst; enucleation

Answer: B. Vitality testing distinguishes periodontal from endodontic abscesses; combined endo-perio lesions are classified by the 2017 scheme with and without root damage.

Question 20

The recommended interval for supportive periodontal care in a treated stage III grade C patient who smokes is:

1. Annually
2. Every three months, individualised by periodontal risk assessment (bleeding on probing, residual pockets, tooth loss, bone loss relative to age, systemic factors, smoking), because recurrence is most likely in high-risk patients who lapse from maintenance
3. Every two years
4. Only when symptoms appear

Answer: B. Compliance with supportive care is the strongest predictor of tooth retention after periodontal treatment.

How to practise

• Learn the 2017 classification cold: staging, grading, extent, health on a reduced periodontium, peri-implant definitions, recession types.
• Know the treatment sequence and the evidence behind each step, including when antibiotics are and are not justified.
• Understand surgical selection: defect morphology for regeneration, furcation classes, biological width, root coverage predictability.
• Practise under time in the Periodontics bank or the Consultant Periodontics bank, using the error-log method.

Related sets: general dentistry questions, prosthodontics questions and dental hygienist questions. The image-practice plan is in dental exam preparation.

Frequently asked questions

How many questions are in the Prometric periodontics specialist exam?

Typically 100 to 150 single-best-answer MCQs in up to three hours, with a pass mark of about 60%, varying by authority.

Which periodontics topics come up most?

The 2017 classification with staging and grading, treatment sequencing, antibiotics, regenerative versus resective surgery, root coverage, peri-implant disease and the diabetes and smoking links.

Does the exam use the old classification?

No. The 2017 World Workshop classification is the standard; older terms such as aggressive periodontitis may appear only as distractors.

Does the exam cover implant placement?

At the level of treatment planning, soft tissue management and peri-implant disease; surgical placement details are in the oral surgery and implantology papers.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.