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Surgical correction · Periodontics · INBDE Patient Cases

Surgical & Regenerative Periodontal Therapy INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on surgical & regenerative periodontal therapy. 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 surgical and regenerative periodontal therapy: open-flap debridement for a residual deep pocket, regeneration of a contained three-wall infrabony defect with GTR and a bone graft (autograft as the osteogenic gold standard), resective osseous surgery for suprabony horizontal bone loss, a subepithelial connective tissue graft as the gold standard for root coverage versus a free gingival graft for keratinized tissue, functional crown lengthening to reestablish the supracrestal attachment for a restoration, furcation management by grade (Class II regeneration versus Class III tunneling, root resection or extraction), and the requirement of plaque control before any periodontal surgery. Topics include open-flap debridement, resective osseous surgery and gingivectomy, guided tissue regeneration, bone grafts and enamel matrix derivative, mucogingival grafting, crown lengthening, and furcation management.

Case Coverage Map
What each case is testing
A deep pocket that survived the deep cleaning:
Open-flap debridement for residual deep pockets, why it is conservative, the plaque-control prerequisite, and replacing the flap.
A contained vertical defect worth rebuilding:
Regeneration for a three-wall infrabony defect, GTR membrane logic, graft classification (autograft gold standard), and why wall count matters.
Shallow horizontal loss with persistent pockets:
Resective osseous surgery for suprabony/horizontal defects, its support tradeoff, and why horizontal loss is a poor regenerative candidate.
An exposed root the patient wants covered:
Connective tissue graft as the root-coverage gold standard, free gingival graft for keratinized tissue, thin biotype, and atraumatic brushing.
Not enough tooth above the gum to restore:
Functional crown lengthening to reestablish the supracrestal attachment, bone removal, the esthetic variant, and timing the restoration.
Two molars, two different furcation grades:
Class II regeneration vs Class III tunneling/resection/extraction, root resection/hemisection, Class I scaling, and grade-driven choice.
When surgery should wait:
Plaque control as a prerequisite for all periodontal surgery, why operating on uncontrolled plaque fails, and reducing inflammation first.
Patient case: A deep pocket that survived the deep cleaning
0 of 5 answered, 0 correct
Patient
Male, 54 years old
Chief Complaint
Reassessment shows a deep pocket that did not respond to cleaning.
Background and/or Patient History
  • Generalized periodontitis treated with SRP; mostly resolved
  • A residual 7 mm pocket with bleeding persists on a posterior tooth with good access
  • Good plaque control established
Allergies
NKDA
Medications
  • None
Current Findings
  • Residual deep, bleeding pocket after nonsurgical therapy
  • No contained infrabony defect requiring regeneration; goal is access and debridement
  1. Question 1
    Moderate
    A residual deep pocket after SRP, where the goal is to clean the root surface, is treated by:
  2. Question 2
    Moderate
    Open-flap debridement is preferred here over resective osseous surgery because:
  3. Question 3
    Moderate
    A prerequisite before this surgery is:
  4. Question 4
    Moderate
    After the flap is reflected and the root cleaned, the flap is:
  5. Question 5
    Easy
    Success after surgery still depends on:

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Patient case: A contained vertical defect worth rebuilding
0 of 5 answered, 0 correct
Patient
Female, 49 years old
Chief Complaint
Localized deep pocket with an angular bony defect on one tooth.
Background and/or Patient History
  • Isolated deep pocket on the mesial of a molar
  • Radiograph and surgical exposure show a contained three-wall infrabony defect
  • Good plaque control
Allergies
NKDA
Medications
  • None
Current Findings
  • Three-wall infrabony (vertical) defect with remaining bony walls
  • Tooth otherwise restorable and worth retaining
  1. Question 1
    Moderate
    A contained three-wall infrabony defect is an ideal candidate for:
  2. Question 2
    Hard
    If guided tissue regeneration is used, the barrier membrane functions to:
  3. Question 3
    Moderate
    If the patient's own bone were used as graft material, it would be a(n):
  4. Question 4
    Hard
    Why is the number of remaining bony walls so important here?
  5. Question 5
    Moderate
    A horizontal bone loss pattern, by contrast, would be:

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Patient case: Shallow horizontal loss with persistent pockets
0 of 5 answered, 0 correct
Patient
Male, 58 years old
Chief Complaint
Persistent moderate pockets with a flat pattern of bone loss.
Background and/or Patient History
  • Generalized horizontal (suprabony) bone loss with residual 5 to 6 mm pockets after SRP
  • No contained infrabony defects
  • Pocket elimination is the treatment goal
Allergies
NKDA
Medications
  • None
Current Findings
  • Suprabony pockets with horizontal bone loss; positive architecture achievable by recontouring
  • Good plaque control
  1. Question 1
    Moderate
    For residual suprabony pockets with horizontal bone loss where pocket elimination is the goal, an appropriate approach is:
  2. Question 2
    Moderate
    Resective osseous surgery reduces pockets by:
  3. Question 3
    Moderate
    A consequence the patient should be counseled about is:
  4. Question 4
    Moderate
    Resection is chosen here over regeneration because:
  5. Question 5
    Moderate
    If instead this had been a deep, contained three-wall defect, the better choice would have been:

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Patient case: An exposed root the patient wants covered
0 of 5 answered, 0 correct
Patient
Female, 34 years old
Chief Complaint
Gum recession on a front tooth that bothers her esthetically and is sensitive.
Background and/or Patient History
  • Localized gingival recession on a maxillary canine with adequate root surface for coverage
  • Thin biotype; esthetic concern and cervical sensitivity
  • Good plaque control; atraumatic brushing reinforced
Allergies
NKDA
Medications
  • None
Current Findings
  • Recession defect amenable to root coverage
  • No active periodontitis; soft-tissue (plastic) problem
  1. Question 1
    Moderate
    The gold-standard procedure for predictable root coverage of this recession defect is:
  2. Question 2
    Moderate
    If the main goal were instead to increase the band of keratinized tissue (not necessarily cover the root), a suitable procedure is:
  3. Question 3
    Moderate
    Her thin biotype is relevant because it:
  4. Question 4
    Moderate
    Reinforcing atraumatic brushing matters because:
  5. Question 5
    Easy
    This procedure is categorized as:

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Patient case: Not enough tooth above the gum to restore
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Patient
Male, 47 years old
Chief Complaint
A broken-down tooth that needs a crown but has little tooth above the gum.
Background and/or Patient History
  • Subgingival fracture/caries margin with insufficient sound tooth above the gingiva
  • Restoring at the current level would violate the supracrestal attachment
  • Tooth otherwise restorable and worth keeping
Allergies
NKDA
Medications
  • None
Current Findings
  • Inadequate clinical crown / subgingival margin encroaching on the supracrestal attachment
  • Needs restorative space
  1. Question 1
    Moderate
    To create restorative space without violating the supracrestal attachment, the indicated procedure is:
  2. Question 2
    Hard
    Functional crown lengthening typically requires:
  3. Question 3
    Moderate
    Restoring directly on the subgingival margin without crown lengthening would risk:
  4. Question 4
    Moderate
    Crown lengthening done to correct a 'gummy' smile is termed:
  5. Question 5
    Moderate
    After crown lengthening, the restoration should ideally wait until:

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Patient case: Two molars, two different furcation grades
0 of 5 answered, 0 correct
Patient
Female, 60 years old
Chief Complaint
Two back teeth with furcation problems found at exam.
Background and/or Patient History
  • One molar has a Class II furcation (definite horizontal defect, not through-and-through)
  • Another molar has a Class III (through-and-through) furcation
  • Good plaque control
Allergies
NKDA
Medications
  • None
Current Findings
  • Class II furcation on one molar; Class III on another
  • Both teeth being evaluated for management
  1. Question 1
    Moderate
    The Class II furcation is a candidate for:
  2. Question 2
    Hard
    The Class III (through-and-through) furcation more often requires:
  3. Question 3
    Moderate
    Root resection or hemisection works by:
  4. Question 4
    Moderate
    A Class I (incipient) furcation, by contrast, is often managed by:
  5. Question 5
    Easy
    The principle illustrated by these two molars is that:

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Patient case: When surgery should wait
0 of 5 answered, 0 correct
Patient
Male, 52 years old
Chief Complaint
Wants surgery to fix residual pockets but home care is still poor.
Background and/or Patient History
  • Residual pockets after SRP that could benefit from surgery
  • Plaque scores remain high; inconsistent home care
  • Eager to proceed straight to surgery
Allergies
NKDA
Medications
  • None
Current Findings
  • Residual disease that is surgically addressable, but inadequate plaque control
  • No systemic contraindication
  1. Question 1
    Moderate
    The appropriate step before periodontal surgery here is to:
  2. Question 2
    Moderate
    Operating before plaque control is achieved would likely result in:
  3. Question 3
    Moderate
    This requirement applies to:
  4. Question 4
    Moderate
    Establishing plaque control first also helps by:
  5. Question 5
    Easy
    This case reinforces that across periodontics, the foundation of every result is:

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Keep studying
Surgical & Regenerative Periodontal Therapy core recall

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

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