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Step 3 Periodontal Surgery — ORE Part 1 MCQ

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ModeratePeriodontologyStep 3 Periodontal SurgeryORE Part 1

A 50-year-old patient presents with chronic periodontitis that has been treated with Step 1 and Step 2 therapy. At reassessment, several sites still have probing depths of 6–7 mm with bleeding on probing despite good oral hygiene compliance. According to the BSP S3 guidelines, what is the next step in management?

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Correct answer: C — Step 3: Consider surgical periodontal treatment such as open flap debridement or regenerative surgery

The correct answer is C. According to SDCEP/BSP-S3 guidance, Step 3 is indicated when pockets of residual depth (≥6 mm) persist despite optimal completion of Steps 1–2 and good patient compliance. Step 3 management options include further non-surgical approaches at specific sites, or surgical interventions such as open flap debridement and regenerative techniques, or referral for specialist care. Option E (repeat Step 2) is not indicated when Steps 1–2 have been thoroughly completed with good oral hygiene response; repeating non-surgical therapy without surgical consideration would be contrary to the stepwise algorithm. Option D (Step 4 maintenance) is premature—maintenance can only follow successful disease stabilization (Step 3 attempts). Option A (discharge) abandons active management of bleeding, pocketed sites. Option B (systemic antibiotics alone) is not supported as monotherapy for surgical pockets.

Reference: SDCEP (Scottish Dental Clinical Effectiveness Programme). Prevention and Treatment of Periodontal Diseases in Primary Care. Stepwise approach section. Accessed 2024. https://www.periodontalcare.sdcep.org.uk/guidance/planning-treatment/stepwise-approach/ and https://www.periodontalcare.sdcep.org.uk/guidance/managing-disease/periodontitis/