NEET MDS Periodontology Syllabus

What is the classic clinical/radiographic pattern of localized aggressive periodontitis?

Rapid attachment and bone loss localized to first molars and incisors in otherwise healthy young patients, with relatively little plaque/calculus and a familial pattern; arc-shaped (vertical) bone loss around molars.

In the 2017 classification, how is what was formerly called aggressive periodontitis now categorized?

It is no longer a separate entity; it is incorporated into "periodontitis" and typically captured as Grade C (rapid progression), often molar-incisor pattern, Stage III/IV.

What host defect involving neutrophils is commonly associated with aggressive periodontitis?

Neutrophil (PMN) chemotaxis and phagocytosis defects, leading to impaired bacterial clearance.

What is a periodontal abscess and what distinguishes it from a periapical (endodontic) abscess?

A periodontal abscess is a localized purulent infection within the periodontal pocket wall; the tooth is usually vital, with a deep pocket and lateral swelling, whereas a periapical abscess arises from a non-vital pulp with apical pathology.

What is the immediate emergency treatment of an acute periodontal abscess?

Drainage (through the pocket or via incision), debridement/scaling, irrigation, and occlusal adjustment if needed; systemic antibiotics only if there is spreading infection or systemic involvement.

What is the difference between a gingival abscess and a periodontal abscess?

A gingival abscess is a localized acute lesion confined to the marginal gingiva or papilla, often from a foreign body, in a previously healthy site; a periodontal abscess involves the deeper periodontal structures and a pre-existing pocket.

What is the goal and primary instrumentation of non-surgical periodontal therapy (Phase I)?

To control infection by removing supra- and subgingival plaque and calculus through scaling and root planing (SRP) plus oral hygiene instruction, resolving inflammation and reducing pocket depth.

What is the difference between scaling and root planing?

Scaling removes plaque, calculus, and stains from crown and root surfaces; root planing is the further smoothing of the root surface to remove residual calculus and contaminated cementum.

What is "full-mouth disinfection" in non-surgical therapy?

Completing scaling and root planing of the entire mouth within a short period (e.g., 24 hours) often with chlorhexidine, to prevent re-infection of treated sites from untreated pockets (Quirynen protocol).

Which local adjunct is a controlled-release antimicrobial chip placed into pockets during non-surgical therapy?

Chlorhexidine chip (PerioChip); other locally delivered agents include doxycycline gel (Atridox) and minocycline microspheres (Arestin).

What antibiotic combination is most commonly used as a systemic adjunct in aggressive/Grade C periodontitis?

Amoxicillin plus metronidazole (the Van Winkelhoff cocktail), effective against A. actinomycetemcomitans.

What is the primary objective of periodontal flap surgery?

To gain access for thorough root debridement and to reduce or eliminate pockets, while preserving and repositioning the gingival tissues for maintainable architecture.

What is the difference between the modified Widman flap and an apically positioned flap?

The modified Widman flap is an access flap for debridement with minimal bone removal and replaced (not repositioned) tissue; the apically positioned flap is moved apically to reduce pocket depth while preserving keratinized gingiva.

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

GTR uses a barrier membrane to exclude epithelium and gingival connective tissue from the root surface, allowing PDL and bone cells to selectively repopulate the defect and regenerate new attachment apparatus.

Which growth-factor/biologic agents are used to promote periodontal regeneration?

Enamel matrix derivative (Emdogain/EMD), platelet-derived growth factor (PDGF, e.g., GEM-21), and platelet concentrates (PRP/PRF).

What is the difference between gingivectomy and gingivoplasty?

Gingivectomy is excision of the gingival wall to eliminate suprabony pockets; gingivoplasty is reshaping/recontouring the gingiva to restore physiologic form without removing pocket wall per se.

What is the difference between an autograft, allograft, xenograft, and alloplast in periodontal bone grafting?

Autograft: patient's own bone (osteogenic, gold standard); allograft: human donor (e.g., FDBA/DFDBA, osteoinductive); xenograft: another species (e.g., bovine Bio-Oss, osteoconductive); alloplast: synthetic material (e.g., hydroxyapatite, osteoconductive).

In periodontal laser therapy, which laser wavelengths are well absorbed by water and pigment, making them useful for soft-tissue and pocket procedures?

Diode (810-980 nm), Nd:YAG (1064 nm), and erbium lasers (Er:YAG 2940 nm, Er,Cr:YSGG 2780 nm); erbium lasers can also ablate calculus and bone.

What does LANAP stand for and what is its purpose?

Laser-Assisted New Attachment Procedure, an FDA-cleared Nd:YAG protocol that selectively removes diseased pocket epithelium and bacteria while aiming to promote periodontal regeneration/new attachment.

What is a key advantage of erbium (Er:YAG) lasers over diode/Nd:YAG lasers in periodontal therapy?

Erbium lasers can ablate hard tissue (calculus and bone) and are absorbed by both water and hydroxyapatite, allowing root debridement, whereas diode/Nd:YAG are primarily soft-tissue lasers.

What is supportive periodontal therapy (SPT) / periodontal maintenance and its typical recall interval?

Ongoing care after active therapy involving periodic exam, reinforcement of hygiene, and professional debridement to prevent recurrence; the typical recall interval is every 3 months, adjusted by risk.

What does each maintenance recall visit (Ramfjord's regimen) include?

Updated medical/dental history, plaque and bleeding assessment, full periodontal probing/charting, evaluation of mobility/furcations, radiographs as needed, oral hygiene reinforcement, and supra/subgingival debridement with polishing.

What is the proposed two-way relationship between periodontitis and cardiovascular disease?

Periodontal pathogens and chronic inflammation can enter the bloodstream, contributing to endothelial dysfunction, atheroma formation, and elevated systemic inflammatory markers (e.g., CRP), increasing atherosclerotic cardiovascular risk.

What antibiotic prophylaxis consideration applies to periodontal procedures in at-risk cardiac patients?

Patients with high-risk cardiac conditions (e.g., prosthetic valves, prior infective endocarditis, certain congenital defects) may require antibiotic prophylaxis (typically amoxicillin 2 g 1 hour before) to prevent infective endocarditis from bacteremia.

How does diabetes mellitus affect periodontal disease (the bidirectional relationship)?

Diabetes (especially poorly controlled) is a major risk factor that worsens periodontitis via AGEs, impaired neutrophil function, and increased inflammation; conversely, periodontitis worsens glycemic control, and periodontal treatment can modestly lower HbA1c.

What HbA1c value generally indicates well-controlled diabetes relevant to periodontal grading?

HbA1c <7.0% indicates good control (Grade B influence), whereas HbA1c ≥7.0% in a periodontitis patient pushes the grade toward Grade C (rapid progression).

What is pregnancy-associated gingivitis and the "pregnancy tumor"?

Hormonally exaggerated gingival inflammation (raised estrogen/progesterone increase vascularity and the response to plaque); the pregnancy tumor is a pyogenic granuloma (granuloma gravidarum), a benign vascular gingival overgrowth, often on the interdental papilla.

Why is periodontitis a concern during pregnancy regarding birth outcomes?

Maternal periodontal infection/inflammation has been associated with an increased risk of preterm birth and low birth weight, possibly via inflammatory mediators (PGE2, IL-6, TNF-α) and bacteremia affecting the fetal-placental unit.

What is the proposed link between periodontal disease and respiratory diseases such as pneumonia and COPD?

Dental plaque can serve as a reservoir for respiratory pathogens that are aspirated into the lower airway, contributing to aspiration pneumonia (especially in the elderly/ICU) and exacerbations of COPD; improved oral hygiene reduces risk.

What dimensions define a successful (machined-surface) implant according to Albrektsson's criteria for osseointegration?

Immobility, no peri-implant radiolucency, marginal bone loss <0.2 mm annually after the first year (<1.5 mm first year), and absence of pain/infection/paresthesia.

What is the difference between peri-implant mucositis and peri-implantitis?

Peri-implant mucositis is reversible inflammation of soft tissue around an implant without bone loss; peri-implantitis adds progressive loss of supporting peri-implant bone.

What is osseointegration?

A direct structural and functional connection between ordered living bone and the surface of a load-bearing implant, without intervening fibrous tissue (Brånemark).

What is the goal of periodontal plastic (mucogingival) surgery?

To correct defects in the morphology, position, or amount of gingiva and alveolar mucosa—e.g., root coverage of recession, augmentation of keratinized tissue, ridge preservation, and esthetic crown lengthening.

What is the Miller classification of gingival recession (and its successor)?

Miller Class I-IV based on recession relative to the mucogingival junction and interdental bone/soft tissue loss (Class I/II have potential for complete root coverage); the 2017 Cairo Recession Type (RT1-RT3) classification now refines this using interproximal attachment loss.

What is the gold-standard graft for predictable root coverage and increasing keratinized tissue?

The subepithelial connective tissue graft (CTG), typically harvested from the palate and used with a coronally advanced flap.

What is a free gingival graft and its primary indication?

A graft of epithelium and connective tissue taken from the palate and placed on a prepared recipient bed; primarily indicated to increase the width/zone of attached keratinized gingiva (less predictable for root coverage than CTG).

What is microsurgery in periodontics and its main advantages?

Periodontal surgery performed with magnification (surgical microscope/loupes), microsurgical instruments, and fine sutures, allowing improved precision, atraumatic tissue handling, better wound closure/primary intention healing, enhanced blood supply, and superior esthetic outcomes.

What suture size and key principle characterize periodontal microsurgery?

Use of very fine sutures (e.g., 6-0 to 9-0) with passive, tension-free, precise wound apposition under magnification to maximize primary-intention healing and minimize trauma.

What is the difference between repair, reattachment, and new attachment in periodontal healing?

Repair: healing without restoration of original architecture (often long junctional epithelium); reattachment: reunion of connective tissue with a root surface that was not pathologically exposed; new attachment: formation of new cementum, PDL, and bone on a previously diseased, exposed root surface (true regeneration).

What is the difference between the gingival sulcus depth in health and a periodontal pocket?

A healthy gingival sulcus probes ≤3 mm with no attachment loss; a periodontal pocket is a pathologically deepened sulcus (>3 mm) caused by gingival enlargement (pseudopocket) or apical migration of the junctional epithelium (true pocket).

What index measures gingival bleeding and inflammation, and what does the Löe and Silness Gingival Index score range represent?

The Gingival Index (GI) scores 0-3: 0 = normal gingiva, 1 = mild inflammation/no bleeding on probing, 2 = moderate inflammation/bleeding on probing, 3 = severe inflammation/spontaneous bleeding.