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Reading the periodontium · Periodontics · INBDE Patient Cases

Periodontal Diagnosis & Classification INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on periodontal diagnosis & classification. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

7 patient cases35 linked questionsADA INBDE formatFull distractor explanations

Seven ADA INBDE-format patient cases on periodontal diagnosis and the 2017 classification: a recession case where shallow probing depth hides attachment loss and clinical attachment level (probing depth plus recession) reveals it, staging a severe new patient as Stage IV with the stage set by the worst site, grading a young heavy smoker with rapid bone loss as Grade C, grading a molar furcation defect (Glickman Grade II versus IV), distinguishing vertical infrabony from horizontal bone loss on the radiograph and the regenerative implication of remaining bony walls, interpreting absence of bleeding on probing as stability in a treated patient with health on a reduced periodontium, and applying the periodontitis case definition of interdental attachment loss at two or more non-adjacent teeth. Topics include probing depth, clinical attachment level, bleeding on probing, furcation and mobility, radiographic bone loss, and staging and grading.

Case Coverage Map
What each case is testing
Shallow pockets but a lot of attachment lost:
Why probing depth understates loss in recession, CAL as probing depth plus recession, and recording both with bleeding for inflammation.
Staging a new patient with advanced disease:
Staging by severity and complexity, Stage IV with tooth loss and rehab needs, staging set by the worst site and not lowered by treatment.
Fast progression for the patient's age:
Grading by rate and risk, the bone-loss-to-age proxy, smoking as a grade modifier, and Grade C implications for therapy intensity.
A molar with bone loss into the furca:
Furcation involvement in multirooted teeth, Glickman grading (Grade II vs IV), why furcations worsen prognosis, and management focus.
An angular bony defect on one tooth:
Vertical (infrabony) vs horizontal bone loss, reading the film with probing, and why contained defects with bony walls are regenerative candidates.
A treated patient with no bleeding at recall:
BOP absence as a stability predictor, health on a reduced periodontium, supportive periodontal therapy, and recognizing recurrence.
Is this periodontitis or just localized recession?:
The 2017 case definition (interdental CAL at 2+ non-adjacent teeth), excluding non-periodontal causes, and proceeding to stage, grade, and extent.
Patient case: Shallow pockets but a lot of attachment lost
0 of 5 answered, 0 correct
Patient
Male, 60 years old
Chief Complaint
Long teeth and sensitivity, but the hygienist says the pockets are shallow.
Background and/or Patient History
  • Generalized recession with the gingival margin well apical to the CEJ
  • Probing depths are mostly 2 to 3 mm because of the recession
  • Significant root exposure
Allergies
NKDA
Medications
  • None
Current Findings
  • Shallow probing depths but substantial recession (margin apical to CEJ)
  • Considerable total attachment loss when recession is added
  1. Question 1
    Moderate
    Why might probing depth alone underestimate this patient's disease?
  2. Question 2
    Moderate
    The measurement that reveals the true loss here is:
  3. Question 3
    Hard
    If a site probes 3 mm with 4 mm of recession, the clinical attachment loss is:
  4. Question 4
    Moderate
    Because the loss is largely recession with shallow pockets, the inflammation status is judged by:
  5. Question 5
    Easy
    The lesson is that periodontal diagnosis requires:

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Patient case: Staging a new patient with advanced disease
0 of 5 answered, 0 correct
Patient
Female, 62 years old
Chief Complaint
Loose teeth and several teeth already lost to gum disease.
Background and/or Patient History
  • History of multiple teeth lost to periodontitis
  • Severe interdental attachment loss and deep pockets in remaining teeth
  • Will need complex rehabilitation
Allergies
NKDA
Medications
  • None
Current Findings
  • Extensive bone loss, several missing teeth due to periodontitis, complex restorative needs
  • Most severe sites show advanced CAL and bone loss
  1. Question 1
    Moderate
    Staging this patient is based primarily on:
  2. Question 2
    Moderate
    Extensive tooth loss due to periodontitis and complex rehabilitation needs point to:
  3. Question 3
    Moderate
    The stage is determined by:
  4. Question 4
    Hard
    After successful treatment, this patient's stage will:
  5. Question 5
    Moderate
    Grading would additionally describe:

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Patient case: Fast progression for the patient's age
0 of 5 answered, 0 correct
Patient
Male, 35 years old
Chief Complaint
Gum disease that seems to be getting worse quickly.
Background and/or Patient History
  • Heavy smoker (one pack per day)
  • Radiographic bone loss is high relative to the patient's young age
  • Rapid progression documented over a short interval
Allergies
NKDA
Medications
  • None
Current Findings
  • Bone loss percentage high for age; rapid documented progression
  • Heavy smoking as a major risk factor
  1. Question 1
    Moderate
    Grading reflects:
  2. Question 2
    Moderate
    Bone loss that is high relative to age suggests:
  3. Question 3
    Moderate
    Heavy smoking modifies the grade by:
  4. Question 4
    Moderate
    This patient is therefore most consistent with:
  5. Question 5
    Moderate
    Recognizing Grade C is clinically important because it:

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Patient case: A molar with bone loss into the furca
0 of 5 answered, 0 correct
Patient
Female, 58 years old
Chief Complaint
A back tooth that traps food and is hard to clean.
Background and/or Patient History
  • Mandibular molar with attachment loss in the furcation area
  • The furcation probe passes partway into the furca but not through
  • Food impaction and difficulty cleaning the area
Allergies
NKDA
Medications
  • None
Current Findings
  • Definite horizontal furcation defect that does not pass through (Grade II)
  • Generalized moderate periodontitis
  1. Question 1
    Easy
    Furcation involvement specifically occurs in:
  2. Question 2
    Hard
    A definite horizontal furcation defect that does not pass through is graded:
  3. Question 3
    Moderate
    Furcation involvement worsens the prognosis because:
  4. Question 4
    Moderate
    Management of this furcation focuses on:
  5. Question 5
    Moderate
    If the defect later became clinically visible through-and-through, it would be:

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Patient case: An angular bony defect on one tooth
0 of 5 answered, 0 correct
Patient
Male, 49 years old
Chief Complaint
Localized deep pocket on one tooth found at recall.
Background and/or Patient History
  • Isolated deep pocket on the mesial of a molar
  • Radiograph shows an angular (vertical) bony defect along that root surface
  • Adjacent teeth have relatively normal bone levels
Allergies
NKDA
Medications
  • None
Current Findings
  • Vertical (angular) infrabony defect on one root surface
  • Surrounding bone relatively intact
  1. Question 1
    Moderate
    An angular defect along one root surface, with relatively intact surrounding bone, is:
  2. Question 2
    Hard
    Compared with horizontal bone loss, a vertical (infrabony) defect is:
  3. Question 3
    Moderate
    The radiograph showing this defect should be interpreted:
  4. Question 4
    Moderate
    A contained vertical defect with remaining bony walls is specifically relevant because it:
  5. Question 5
    Hard
    Mapping the number of remaining bony walls of the defect matters because it:

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Patient case: A treated patient with no bleeding at recall
0 of 5 answered, 0 correct
Patient
Female, 55 years old
Chief Complaint
Periodontal maintenance recall after prior treatment.
Background and/or Patient History
  • Treated for periodontitis two years ago; on a maintenance program
  • Reduced but stable attachment; no bleeding on probing today
  • Good home care
Allergies
NKDA
Medications
  • None
Current Findings
  • No BOP; pocket depths stable; reduced periodontium from prior disease
  • No new attachment loss since treatment
  1. Question 1
    Moderate
    The absence of bleeding on probing at this recall suggests:
  2. Question 2
    Hard
    This patient is best categorized as having:
  3. Question 3
    Moderate
    The appropriate plan is:
  4. Question 4
    Moderate
    If bleeding on probing and deepening pockets appeared at a future recall, it would indicate:
  5. Question 5
    Moderate
    This case shows that bleeding on probing is most useful clinically as:

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Patient case: Is this periodontitis or just localized recession?
0 of 5 answered, 0 correct
Patient
Male, 44 years old
Chief Complaint
Routine exam; the clinician must decide whether the diagnosis is periodontitis.
Background and/or Patient History
  • Interdental attachment loss detectable at several non-adjacent teeth
  • One area of isolated recession from aggressive brushing is also present
  • Need to apply the 2017 case definition
Allergies
NKDA
Medications
  • None
Current Findings
  • Interdental CAL at two or more non-adjacent teeth, not explained by non-periodontal causes
  • Separate localized recession attributable to brushing trauma
  1. Question 1
    Hard
    The 2017 case definition of periodontitis generally requires:
  2. Question 2
    Hard
    The isolated recession from aggressive brushing should be:
  3. Question 3
    Moderate
    Given interdental CAL at two or more non-adjacent teeth, the diagnosis here is:
  4. Question 4
    Moderate
    Applying the case definition matters because it:
  5. Question 5
    Moderate
    After establishing periodontitis, the next diagnostic steps are to:

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Keep studying
Periodontal Diagnosis & Classification core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

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