Implant-related therapy practice questions for the periodontics Qualifying Exam
Implant therapy covers site development, placement and the treatment of peri-implant disease. Expect ridge and sinus dimensions in the stem and a decision about technique, timing or management.
The 2027 Qualifying Exam blueprint lists these objectives for this domain:
Alveolar ridge preservation after extraction
Hard and soft tissue augmentation of edentulous ridges
Transcrestal and lateral window sinus augmentation, and osseodensification
Osseointegration and implant stability at placement
Immediate, early and delayed placement, and perioperative complications
Non-surgical and surgical management of peri-implant diseases
Managing peri-implant soft and hard tissue deficiencies
High-yield areas
Residual bone height and the choice of crestal or lateral sinus approach
Dimensional change after extraction, with and without ridge preservation
Placement timing types and the buccal plate
Insertion torque, resonance frequency analysis and loading decisions
EFP 2023 peri-implantitis guideline: what works, and when to explant
How to study it
Work from dimensions: given a ridge width, a bone height or a defect, pick the procedure and the timing. Learn the complications by anatomy, such as sinus membrane perforation, sublingual bleeding and nerve injury.
Free practice questions: Implant-related therapy
4 questions from the bank, with the full rationale and source. Pick your answer, then open the rationale.
Question 1 of 4 · moderateImplant-Related Therapy
A 55-year-old had an implant placed with simultaneous GBR in the mandibular first molar site, and primary closure was obtained by releasing and advancing the buccal flap. At uncovering 5 months later, the implant is integrated, but there is almost no keratinized mucosa on the buccal aspect, whereas a 3 mm band was present before surgery. What is the most likely explanation?
Resorption of the bone graft beneath the band of keratinized mucosa
Coronal mucogingival junction shift from buccal flap advancement
Necrosis of the keratinized tissue from membrane exposure
Peri-implant mucositis destroying the keratinized band
Lingual flap advancement displacing the buccal tissue
Show answer and rationale
Answer: B. Coronal mucogingival junction shift from buccal flap advancement
A (incorrect): Graft remodeling changes ridge contour but does not convert keratinized mucosa into alveolar mucosa. The change here reflects where the tissue was moved.
B (correct): Advancing the buccal flap for primary closure carries the mucogingival junction coronally, which leaves mobile alveolar mucosa where keratinized tissue used to be. After ridge preservation with flap closure, the junction moved about 3.8 mm compared with about 1.2 mm with open healing, and the loss is more pronounced on the buccal side.
C (incorrect): Membrane exposure reduces bone fill but would present as a dehiscence during healing. It does not explain a coronal shift of mobile mucosa over an intact closure.
D (incorrect): Mucositis is inflammation of the peri-implant mucosa and does not eliminate keratinized tissue. The implant has only just been uncovered.
E (incorrect): Primary closure normally relies on advancing the buccal flap to meet the lingual flap. The buccal advancement is what moves the junction on that side.
Source: Hämmerle CHF, Tarnow D. The etiology of hard- and soft-tissue deficiencies at dental implants: A narrative review. J Clin Periodontol. 2018;45(Suppl 20):S267-S277. Soft-tissue deficiencies prior to implant placement: Keratinized tissue. https://doi.org/10.1111/jcpe.12955
Question 2 of 4 · moderateImplant-Related Therapy
A bone-level implant is planned for a missing maxillary right central incisor. The contralateral central incisor has no gingival recession. The surgeon is choosing how deep to place the implant shoulder. Which apico-coronal position is most appropriate?
About 3 mm apical to the planned mucosal margin of the crown
Level with the planned mucosal margin of the crown
About 1 mm apical to the planned mucosal margin of the crown
Level with the cemento-enamel junction of the adjacent teeth
About 6 mm apical to the planned mucosal margin of the final crown
Show answer and rationale
Answer: A. About 3 mm apical to the planned mucosal margin of the crown
A (correct): A shoulder about 3 mm apical to the emergence of the future restoration gives room for the peri-implant soft tissue attachment and a gradual emergence profile. In a patient without recession this corresponds to about 1 mm apical to the cemento-enamel junction of the contralateral tooth.
B (incorrect): A shoulder at the mucosal margin leaves no room for the soft tissue attachment or emergence profile, and the restorative margin would be visible. It is too shallow for an esthetic anterior site.
C (incorrect): One millimeter does not allow for the expected 3 mm of soft tissue attachment. Bone tends to remodel apically to re-establish this dimension.
D (incorrect): The reference point is about 1 mm apical to the contralateral CEJ, not level with it. Placing the shoulder at the CEJ makes the implant too shallow.
E (incorrect): An excessively deep platform creates a deep mucosal tunnel that is hard to clean and probe and is a risk for peri-implant disease. It also lengthens the prosthetic components.
A maxillary first premolar is extracted atraumatically. All socket walls are present, but the facial bone measures 0.8 mm. Alveolar ridge preservation is done with deproteinized bovine bone mineral with collagen, sealed with a porcine collagen matrix. The patient asks whether the ridge will stay the same size until the implant is placed. Which response is most accurate?
The graft prevents dimensional change, so the original ridge width will be kept
Most contraction will be on the palatal side, because the facial wall has been grafted
Some contraction, mainly facial, is still expected, and extra grafting may be needed
Contraction will be minimal, because thin facial bone responds best to socket grafting
The xenograft will be fully replaced by vital bone within 3 months, preventing collapse
Show answer and rationale
Answer: C. Some contraction, mainly facial, is still expected, and extra grafting may be needed
A (incorrect): No ridge preservation protocol prevents all remodeling. Volumetric analyses showed reduction of the ridge over time despite grafting and sealing.
B (incorrect): Grafting does not shift remodeling to the palatal side. The facial aspect remains the site of most contraction after ridge preservation.
C (correct): Even after ridge preservation with this protocol, the ridge contracts over time, mainly on the facial aspect. These changes are more pronounced when baseline facial bone is 1 mm or less, and baseline buccal thickness strongly predicted bone and soft tissue modeling. Ancillary augmentation was still needed at 16.7% of sites in this trial.
D (incorrect): Thin facial bone predicts more, not less, contraction. Dimensional changes after ridge preservation were more pronounced at sites with facial bone of 1 mm or less.
E (incorrect): Bovine bone mineral degrades slowly, and residual particles were still present at 9 months. Replacement by vital bone is gradual and does not occur within 3 months.
Source: Couso-Queiruga E, Weber HA, Garaicoa-Pazmino C, Barwacz C, Kalleme M, Galindo-Moreno P, et al. Influence of healing time on the outcomes of alveolar ridge preservation using a collagenated bovine bone xenograft: a randomized clinical trial. J Clin Periodontol. 2023;50(2):132-146. Abstract, Results and Conclusions. https://pmc.ncbi.nlm.nih.gov/articles/PMC10100450/
Question 4 of 4 · easyImplant-Related Therapy
A 52-year-old woman receives a mandibular first molar implant in healed bone with an insertion torque of 35 Ncm and an ISQ of 72. She asks when her implant will be most vulnerable to movement while it heals. Based on the balance between primary and secondary stability, when is overall stability expected to be lowest?
Immediately after the implant is inserted
About 5 to 6 weeks after placement
About 2 to 3 weeks after placement
About 3 to 4 months after placement
About 6 to 12 months after functional loading
Show answer and rationale
Answer: C. About 2 to 3 weeks after placement
A (incorrect): At insertion the implant has its full mechanical engagement with the host bone, which is why insertion torque and ISQ are recorded then. Stability starts falling only after the inflammatory resorption phase begins.
B (incorrect): By weeks 5 to 6 biological stabilization typically reaches a functional plateau as early osseointegration is completed. Overall stability is recovering at this point, not at its lowest.
C (correct): Primary mechanical stability declines over the first weeks as surgical trauma triggers resorption of the compressed bone at the interface, while new bone has not yet replaced it. The sum of mechanical and biological stability therefore reaches its low point in this window, with the minimum usually around week 3. Adequate primary stability at placement is what carries the implant through it.
D (incorrect): By 3 to 4 months bone has formed and matured at the interface in a healed site, and this is a common time for conventional loading. Stability has usually recovered from the early dip by then.
E (incorrect): Remodeling continues after loading, but the early dip in stability is a feature of the first weeks after surgery. Late changes in this period relate to marginal remodeling and peri-implant health rather than the primary-to-secondary transition.
Source: Tisci A, Fanelli F, Caponio VCA, Zhurakivska K, et al. Resonance frequency analysis and clinical outcomes in implant dentistry: A systematic review and meta-analysis. Clin Implant Dent Relat Res. 2026;28:e70156. Introduction, paragraph 2, and Discussion. https://pmc.ncbi.nlm.nih.gov/articles/PMC13163645/
For exam preparation only, not clinical advice.
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