National Board Dental Examination / Integrated National Board Dental Examination (INBDE) Periodontics and Oral Surgery Syllabus

What is the primary goal and main instrument category of nonsurgical periodontal therapy?

Disruption/removal of subgingival biofilm and calculus to reduce inflammation; performed by scaling and root planing (SRP) with hand curettes (e.g., Gracey) and ultrasonic scalers.

What is the difference between scaling and root planing?

Scaling removes plaque and calculus from crown/root surfaces; root planing additionally removes contaminated cementum/dentin to leave a smooth, biocompatible root surface.

Which area-specific Gracey curettes are used for posterior buccal/lingual versus mesial versus distal surfaces?

Gracey 7/8 (and 11/12) for buccal/lingual; Gracey 11/12 for mesial surfaces; Gracey 13/14 for distal surfaces of posterior teeth.

What is the recommended toothbrushing technique for sulcular plaque removal?

The modified Bass technique: bristles angled 45 degrees to the long axis into the gingival sulcus with short vibratory/circular strokes.

What is the rationale and timing for periodontal re-evaluation after SRP?

Re-evaluate ~4-6 weeks after SRP to allow tissue healing, then reassess probing depths, BOP, and attachment to decide on maintenance versus surgical therapy.

What is the main objective of periodontal flap surgery?

To gain access for root debridement and to reduce/eliminate pockets while preserving or regenerating attachment, allowing visualization of root surfaces and osseous defects.

Differentiate gingivectomy from apically positioned flap.

Gingivectomy excises and removes pocket wall (used for suprabony pockets/gingival overgrowth with adequate keratinized tissue); apically positioned flap repositions tissue apically to reduce pockets while preserving keratinized gingiva.

What is guided tissue regeneration (GTR) and its principle?

Use of a barrier membrane to exclude epithelium/gingival connective tissue, allowing PDL and bone cells to repopulate the defect and regenerate true attachment; works best in narrow 3-wall intrabony defects and Class II furcations.

What biologic agent derived from porcine tooth buds is used to promote periodontal regeneration?

Enamel matrix derivative (EMD, e.g., Emdogain), which mimics developmental cementogenesis to stimulate periodontal regeneration.

How are furcation involvements classified (Glickman)?

Grade I: incipient/horizontal loss within enamel; Grade II: cul-de-sac, partial horizontal loss; Grade III: through-and-through but soft-tissue covered; Grade IV: through-and-through and clinically visible.

What is the recommended periodontal maintenance recall interval for most treated periodontitis patients?

Every 3 months (3-month recall) for supportive periodontal therapy, adjusted by risk and disease control.

What does supportive periodontal therapy (maintenance) typically include?

Update of medical/dental history, plaque/BOP assessment, full periodontal charting, oral hygiene reinforcement, supra/subgingival debridement, and determination of recall interval.

How does diabetes mellitus interrelate with periodontal disease (bidirectional relationship)?

Diabetes (especially poor glycemic control) increases periodontitis severity via AGEs and exaggerated inflammation; conversely, periodontitis worsens glycemic control. Periodontal treatment can modestly lower HbA1c.

What is the proposed link between periodontitis and cardiovascular disease?

Chronic periodontal infection contributes to systemic inflammation, bacteremia, and atherogenesis; periodontal pathogens have been found in atheromatous plaques (association, not proven causation).

What adverse pregnancy outcome is associated with maternal periodontitis?

Increased risk of preterm low birth weight, thought to be mediated by inflammatory mediators (PGE2, IL-1) and bacteremia.

What is the recommended preoperative chair/patient positioning consideration for maxillary versus mandibular extractions?

For maxillary extractions the occlusal plane is ~60 degrees to the floor with the chair higher; for mandibular extractions the occlusal plane is parallel to the floor with the chair lower (near operator elbow level).

What two basic mechanical principles govern simple (forceps) exodontia?

Use of the tooth as a lever and the expansion of the bony socket; controlled forces (apical, buccal-lingual, rotational, tractional) luxate and deliver the tooth.

What is the function of a dental elevator, and what three working principles does it use?

To luxate teeth/roots and expand bone; it uses the lever (most common), wheel-and-axle, and wedge principles.

When is a surgical (open) extraction with flap and bone removal indicated?

For impacted/ankylosed teeth, hypercementosis, divergent or curved roots, root fracture during simple extraction, thick/dense bone, or thin fragile roots likely to fracture.

What are the cardinal signs and management of a dry socket (alveolar osteitis)?

Severe throbbing pain 2-4 days post-extraction with empty/denuded socket and fetid odor due to lost clot. Management: gentle irrigation and medicated (eugenol) dressing for palliation; not an infection, so antibiotics are not routinely needed.

How is an oroantral communication managed based on size?

<2 mm: clot stabilization, no surgical closure; 2-6 mm: figure-of-eight suture and sinus precautions, antibiotics, decongestants; >6 mm: surgical flap closure (buccal advancement or buccal fat pad).

What is the immediate management if a tooth or root tip is displaced into the maxillary sinus?

Attempt retrieval via the socket with suction/irrigation; if unsuccessful, refer for surgical retrieval (e.g., Caldwell-Luc or endoscopic approach) and provide antibiotics/decongestants/sinus precautions.

What is the fundamental surgical principle for managing an odontogenic infection with an abscess?

Incision and drainage (I&D) to establish drainage, plus removal of the source (extraction or endodontic treatment); antibiotics are adjunctive, not a substitute for drainage.

What is Ludwig's angina and why is it an emergency?

A rapidly spreading bilateral cellulitis of the submandibular, sublingual, and submental spaces; it threatens the airway by elevating/displacing the tongue, requiring airway management, IV antibiotics, and surgical drainage.

Which fascial space is involved when a mandibular molar infection perforates lingual to the mylohyoid muscle versus buccal/below it?

Above the mylohyoid attachment (or roots above it) drains to the sublingual space; below the mylohyoid attachment drains to the submandibular space (second/third molar roots typically below).

Differentiate excisional from incisional biopsy and when each is indicated.

Excisional removes the entire lesion with a margin (small <1 cm, benign-appearing lesions); incisional removes a representative portion (large lesions or suspected malignancy) to establish diagnosis before definitive treatment.

What is the appropriate management/biopsy approach for a suspected malignant oral lesion that does not resolve in 2 weeks?

Incisional biopsy including a margin of normal tissue (avoid necrotic center), or referral; persistent ulcer/leukoplakia >2 weeks warrants biopsy to rule out squamous cell carcinoma.

What is the recommended management sequence (ABCDE) and priority for a patient with maxillofacial trauma?

Follow ATLS: Airway (with C-spine control), Breathing, Circulation/hemorrhage control, Disability, Exposure — life-threatening issues before definitive fracture repair.

What is the recommended storage medium and time limit for an avulsed permanent tooth before replantation?

Replant immediately if possible; otherwise store in Hank's Balanced Salt Solution, cold milk, or saliva. PDL cells begin to die after ~30-60 minutes of dry time; avoid water and scrubbing the root.

What defines successful osseointegration of a dental implant (Branemark concept)?

Direct structural and functional connection between living bone and the implant surface without intervening fibrous tissue, clinically immobile and asymptomatic under load.

What is the difference between primary (mechanical) and secondary (biological) implant stability?

Primary stability is the mechanical engagement of the implant with bone at placement (no micromotion); secondary stability develops from osseointegration (new bone formation) over healing, replacing primary stability.

Compare autograft, allograft, xenograft, and alloplast in bone grafting.

Autograft (patient's own bone): osteogenic, osteoinductive, osteoconductive (gold standard); allograft (human donor, e.g., FDBA/DFDBA): osteoinductive/conductive; xenograft (e.g., bovine, Bio-Oss): osteoconductive scaffold; alloplast (synthetic, e.g., HA/TCP): osteoconductive only.