Implant restorations practice questions for the periodontics Qualifying Exam

Answer: B. Explore the submucosal area and remove any residual cement

A (incorrect): Antibiotics do not remove a foreign body that is sustaining the inflammation. Without removing the cement, the lesion will recur. B (correct): Excess cement was associated with signs of peri-implant disease in most affected implants in an endoscopic study, and clinical and endoscopic signs of inflammation resolved in 74% of test implants 30 days after the cement was removed. Removing the crown or exploring the site to eliminate cement is the logical first step. C (incorrect): Regenerative surgery is not the first step when a removable local cause is likely. It would be premature before the cement has been found and removed and the response assessed. D (incorrect): Occlusal overload is not an established cause of peri-implant inflammation, and a single site with suppuration under a subgingival cement margin points to a local plaque-retentive factor. E (incorrect): An antiseptic rinse cannot reach or remove submucosal cement. Waiting 3 months allows a potentially reversible lesion to progress.

Source: Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009;80(9):1388-1392. Abstract, Results and Conclusions. https://pubmed.ncbi.nlm.nih.gov/19722787/

Answer: C. Early loading

A (incorrect): Immediate loading means the implant is connected to a prosthesis in occlusion within 1 week of placement. A crown delivered at 6 weeks is well outside that window. B (incorrect): Immediate restoration describes a prosthesis connected within 1 week but held out of occlusion. Here the crown is placed at 6 weeks and in full contact, so neither element of the definition applies. C (correct): Early loading is connection of the prosthesis between 1 week and 2 months after implant placement. A crown placed in occlusion at 6 weeks falls squarely in this window, and early loading is a well-documented routine option in healed sites without modifiers. D (incorrect): Conventional loading requires a healing period of more than 2 months with no prosthesis connected. Loading at 6 weeks is earlier than this. E (incorrect): Progressive loading refers to a stepwise increase in occlusal load over time with staged provisional adjustments. It is not one of the time-based categories used in the ITI placement and loading classification.

Source: Morton D, Gallucci G, Lin WS, et al. Group 2 ITI Consensus Report: Prosthodontics and implant dentistry. Clin Oral Implants Res. 2018;29(Suppl 16):215-223. Section 4.2, Definition of terms (implant loading protocols). https://doi.org/10.1111/clr.13298

Answer: B. Immediate restoration of a late-placed implant

A (incorrect): Immediate loading requires the prosthesis to be in occlusion with the opposing arch within 1 week. This crown was deliberately kept out of all occlusal contact. B (correct): Immediate restoration is connection of a prosthesis held out of occlusion within 1 week of placement. The implant went into a site healed for 9 months, which is late placement, so this is late placement with immediate restoration (ITI Type 4A). C (incorrect): Early loading is prosthesis connection between 1 week and 2 months. The crown went in at 2 days, so it is within the immediate window. D (incorrect): Immediate placement means the implant enters the socket on the day of extraction. This tooth was extracted 9 months earlier, so the placement timing is late, not immediate. E (incorrect): Conventional loading means more than 2 months of healing with no prosthesis connected to the implant. A provisional screwed to the implant at 2 days is the opposite of that protocol, even if it is out of occlusion.

Source: Morton D, Gallucci G, Lin WS, et al. Group 2 ITI Consensus Report: Prosthodontics and implant dentistry. Clin Oral Implants Res. 2018;29(Suppl 16):215-223. Section 4.2, Definition of terms (Type 4A; immediate restoration and late placement definitions). https://doi.org/10.1111/clr.13298

Answer: D. More than four implants allowing segmented prostheses

A (incorrect): Four appropriately distributed implants are the recommended minimum for a one-piece full-arch prosthesis, but this gives no reserve if one implant is lost and does not allow segmentation. B (incorrect): Two implants are suitable for retaining a mandibular overdenture, not for supporting a fixed full-arch prosthesis. C (incorrect): Three implants fall below the recommended minimum of four appropriately distributed implants for a one-piece full-arch fixed prosthesis. D (correct): Additional implants provide options for segmented full-arch fixed prostheses, and the impact of future implant loss on prosthesis support should be considered when choosing implant number. Implant survival is similar with fewer than five or with five or more implants, so the extra implants are chosen for prosthetic flexibility, not survival. E (incorrect): Splitting four implants into two 2-implant bridges loses cross-arch stabilization and leaves each segment with no reserve. Segmentation needs more implants than the one-piece minimum.

Source: Morton D, Gallucci G, Lin WS, et al. Group 2 ITI Consensus Report: Prosthodontics and implant dentistry. Clin Oral Implants Res. 2018;29(Suppl 16):215-223. Section 2.2, Consensus statements 1 to 3; Section 2.3, Clinical recommendation 3. https://doi.org/10.1111/clr.13298