Evaluation and maintenance practice questions for the periodontics Qualifying Exam
Maintenance questions test what happens after active therapy: how often to see a patient, what to measure, how to judge a surgical result, and what to do when disease returns.
2027 ABP blueprint domain: Evaluation and Maintenance
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36questions on this domain in the bank
What the blueprint covers
The 2027 Qualifying Exam blueprint lists these objectives for this domain:
Maintenance intervals and procedures, including periodontal and peri-implant examinations
Assessing postsurgical outcomes around teeth and implants
Managing postoperative surgical and prosthetic complications and recurrent disease
High-yield areas
Risk-based recall intervals and the effect of compliance on tooth loss
Baseline probing and radiographs after implant prosthesis delivery
Recurrent periodontitis versus residual pockets
Root caries and dentin hypersensitivity in maintenance patients
Screw loosening, component fracture and graft failure
How to study it
Practice judging change: what counts as a significant increase in probing depth or bone loss, and what the next step is for each finding at a recall visit.
Free practice questions: Evaluation and maintenance
4 questions from the bank, with the full rationale and source. Pick your answer, then open the rationale.
Question 1 of 4 · easyEvaluation and Maintenance
A 54-year-old man is seen for his first supportive periodontal care visit 4 months after completing therapy for stage III periodontitis. The clinician plots the periodontal risk assessment (PRA) functional diagram. Full-mouth BOP and the number of residual pockets of 5 mm or more both fall in the high-risk zone. Tooth loss, bone loss relative to age, systemic and genetic factors, and environmental factors (he has never smoked) all fall in the low-risk zone. Which risk category applies?
High risk, because two parameters fall in the high-risk zone
Moderate risk, because four of the six parameters are low risk
Low risk, because he has no systemic or environmental risk factor
Moderate risk, because his bone loss relative to age is low
Unclassifiable until his interleukin-1 genotype is known
Show answer and rationale
Answer: A. High risk, because two parameters fall in the high-risk zone
A (correct): In the Lang and Tonetti PRA, an individual is high risk when at least two parameters extend into the high-risk zone. BOP and residual pockets are both high here, so he is high risk regardless of the other four vectors, which argues for a short recall interval and treatment of the residual pockets.
B (incorrect): The PRA does not average the vectors or count how many are low. Two parameters in the high-risk zone define a high-risk individual even when the others are favorable.
C (incorrect): Systemic and environmental factors are only two of the six vectors. A nonsmoker without systemic disease can still be high risk when infection-related parameters such as BOP and residual pockets are high.
D (incorrect): Bone loss relative to age is one vector among six. A low bone loss to age ratio does not offset two vectors in the high-risk zone.
E (incorrect): Genetic and systemic information is one vector of the diagram, and the model can be completed without a genotype test. Interleukin-1 testing is not required to classify risk in routine SPC.
Source: Çolak R, Küçükoğlu Çolak M, Ercan S. Periodontal risk assessment and associated factors in young adults: a cross-sectional study. BMC Oral Health. 2026;26(1):1139. Materials and methods, Periodontal risk assessment (PRA) risk group definitions. https://pmc.ncbi.nlm.nih.gov/articles/PMC13326423/
Question 2 of 4 · hardEvaluation and Maintenance
A 39-year-old woman had a coronally advanced flap with a connective tissue graft at a buccal recession on tooth #24 (FDI 31). Before surgery, interproximal attachment loss was 2 mm and buccal attachment loss was 4 mm. At 6 months she has partial root coverage and asks why the root is not fully covered. Which explanation best accounts for the outcome?
The recession was RT2, and interproximal attachment loss limits predictable coverage
Partial coverage shows the graft necrosed and must be repeated within 3 months
The result is expected only in smokers and suggests she has resumed smoking
The recession was RT1, and partial coverage reflects a flap that was not advanced
The procedure failed because a free gingival graft is required on mandibular incisors
Show answer and rationale
Answer: A. The recession was RT2, and interproximal attachment loss limits predictable coverage
A (correct): In RT2 recession the interproximal attachment loss is less than or equal to the buccal attachment loss. Recession type predicts recession reduction after root coverage procedures, and full coverage becomes less predictable as interproximal attachment is lost.
B (incorrect): Partial coverage after 6 months does not indicate graft necrosis. Necrosis appears early, as tissue loss in the first weeks after surgery.
C (incorrect): Smoking can impair root coverage, but the history provides no indication of it. Her interproximal attachment loss is a sufficient explanation.
D (incorrect): RT1 recession has no interproximal attachment loss. Her 2 mm interproximal loss places the defect in RT2.
E (incorrect): Coronally advanced flap with connective tissue graft is a standard option for mandibular incisors. The outcome is limited by the interproximal attachment level, not the choice of graft.
Source: Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011;38(7):661-666. Abstract, Methods and Results. https://pubmed.ncbi.nlm.nih.gov/21507033/
Question 3 of 4 · moderateEvaluation and Maintenance
A periodontist is writing the supportive periodontal care protocol for a multi-clinic group. A colleague proposes replacing conventional professional mechanical plaque removal (PMPR) with Er:YAG laser debridement and adding sub-antimicrobial dose doxycycline for every SPC patient. Which protocol is best supported by current evidence?
Er:YAG laser debridement at every visit in place of hand and powered instruments
Conventional PMPR plus sub-antimicrobial dose doxycycline for every patient
Conventional PMPR plus photodynamic therapy at every bleeding site
Supragingival polishing only, with no subgingival instrumentation in SPC
Conventional PMPR, with subgingival instrumentation of residual pockets
Show answer and rationale
Answer: E. Conventional PMPR, with subgingival instrumentation of residual pockets
A (incorrect): Replacing conventional PMPR with Er:YAG laser treatment is suggested against. The single trial comparing them found no difference, and costs and patient-reported outcomes are unknown.
B (incorrect): Sub-antimicrobial dose doxycycline added to PMPR in SPC showed no significant benefit, and its use is suggested against. Routine host modulation for every patient adds cost and drug exposure without demonstrated gain.
C (incorrect): Adjunctive photodynamic therapy in SPC is also suggested against. Evidence is limited to a single trial without significant differences.
D (incorrect): SPC includes localized subgingival instrumentation at residual pockets, not only supragingival care. Omitting it leaves bleeding residual pockets, the sites most likely to progress, untreated.
E (correct): Routine PMPR at defined intervals, combined with localized subgingival instrumentation of residual pockets, oral hygiene reinforcement and risk factor control, is associated with low tooth loss and stable attachment levels. Alternative or adjunctive technologies have not shown added benefit in SPC.
Source: Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, Sculean A, Tonetti MS; EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4-60. Section 8 introduction and Section 8.4, Recommendations R4.14 to R4.16. https://pmc.ncbi.nlm.nih.gov/articles/PMC7891343/
Question 4 of 4 · hardEvaluation and Maintenance
During access flap surgery for peri-implantitis at an implant at tooth #18 (FDI 37), the periodontist has removed granulation tissue and must now decontaminate the exposed implant threads. Which adjunct to standard mechanical decontamination is best supported?
Photodynamic therapy with a photosensitizer and diode laser
Er:YAG laser irradiation of the exposed threads
Glycine powder air polishing of the exposed threads
Chlorhexidine applied to the threads with soaked pellets
Titanium brushes used on the exposed threads
Show answer and rationale
Answer: E. Titanium brushes used on the exposed threads
A (incorrect): Photodynamic therapy is suggested against for surface decontamination in surgery. It did not improve probing depth reduction and gave only minor bleeding reductions.
B (incorrect): Using Er:YAG laser for implant surface decontamination during surgery is suggested against. Trials showed no consistent benefit on bleeding at 6 and 12 months.
C (incorrect): Air polishing for surface decontamination during peri-implantitis surgery is also suggested against. It did not reduce bleeding in the available trials.
D (incorrect): Chlorhexidine for surface decontamination during peri-implantitis surgery is suggested against. No benefit was observed with its adjunctive use.
E (correct): Titanium brushes may be considered as an alternative or adjunct to standard decontamination during surgical treatment of peri-implantitis. Two trials reported benefits in bleeding or probing depth reduction.
Source: Herrera D, Berglundh T, Schwarz F, Chapple I, Jepsen S, Sculean A, Kebschull M, Papapanou PN, Tonetti MS, Sanz M; EFP workshop participants and methodological consultant. Prevention and treatment of peri-implant diseases: The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023;50(Suppl 26):4-76. Section 8, Recommendations R8.11 and R8.12. https://doi.org/10.1111/jcpe.13823
For exam preparation only, not clinical advice.
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