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In the Pell & Gregory classification of impacted third molars, what does Class III refer to?

Tooth crown is at the level of the occlusal plane

Tooth is entirely below the cervical line of the second molar

Tooth is above the occlusal plane of the second molar

Tooth is between the occlusal plane and the cervical line

to track

2026 Statistics

Key Facts: ABOMS Exam

300+

Qualifying Exam MCQs

ABOMS Qualifying Examination

2-part

Certification Process

Qualifying Examination + Oral Certifying Examination

~13%

Trauma Weight

Largest single domain on 2026 ABOMS content outline

~$2-3K

2026 Combined Fees

ABOMS Qualifying + Oral Certifying (verify current schedule)

4-6 yr

OMFS Residency

CODA-accredited single-degree (4-yr) or dual-degree (6-yr with M.D.)

2022

MRONJ Guidelines

AAOMS Position Paper on MRONJ

ABOMS certification is a 2-part process — a 1-day computer-based Qualifying Examination with 300+ single-best-answer MCQs at Pearson VUE, followed by an Oral Certifying Examination. Content covers trauma (~13%), implantology (~11%), dentoalveolar (~10%), oral pathology (~10%), oral cancer (~10%), orthognathic (~10%), anesthesia (~9%), reconstruction (~9%), TMJ (~6%), odontogenic infections (~5%), pediatric OMFS and cleft (~4%), and ethics/MRONJ (~3%). Combined fees are ~$2,000-$3,000. Requires completion of a CODA-accredited 4-6 year OMFS residency.

Sample ABOMS Practice Questions

Try these sample questions to test your ABOMS exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1In the Pell & Gregory classification of impacted third molars, what does Class III refer to?

A.Tooth crown is at the level of the occlusal plane

B.Tooth is entirely below the cervical line of the second molar

C.Tooth is above the occlusal plane of the second molar

D.Tooth is between the occlusal plane and the cervical line

Explanation: Pell & Gregory depth classification: Class A — highest part of the impacted tooth is at or above the occlusal plane of the second molar; Class B — between the occlusal plane and the cervical line; Class C — below the cervical line of the second molar. Deeper (Class C/III) impactions are more surgically challenging and carry higher risk of IAN injury.

2A mandibular third molar whose long axis is parallel to the second molar and displaced posteriorly toward the ramus is best described as which Winter classification?

A.Mesioangular

B.Distoangular

C.Horizontal

D.Vertical

Explanation: Winter's classification describes angulation of the impacted tooth relative to the long axis of the second molar: mesioangular (most common, easiest), vertical (parallel long axes), horizontal, and distoangular (most difficult because path of withdrawal is blocked by the ramus).

3Which panoramic radiographic sign is MOST predictive of inferior alveolar nerve injury during third molar extraction?

A.Hypercementosis of the root

B.Dilaceration of the mesial root

C.Darkening of the root where it crosses the canal

D.Widening of the periodontal ligament space

Explanation: Rood's criteria include darkening of the root, deflection of the root, narrowing of the root, interruption of the white cortical lines of the canal, diversion of the canal, and narrowing of the canal. Darkening of the root and interruption of the white line have the highest predictive value; when present, CBCT is indicated.

4What is the PRIMARY purpose of alveoloplasty following multiple extractions?

A.Prevent dry socket

B.Accelerate epithelialization

C.Eliminate sharp bony projections and recontour the ridge for prosthesis

D.Provide local anesthesia

Explanation: Alveoloplasty reshapes the alveolar process to remove sharp bony spicules, undercuts, and irregularities that would impede denture seating or cause mucosal irritation. It is commonly performed at the time of extraction (intraseptal or simple) when immediate or conventional dentures are planned.

5Socket preservation grafting is MOST strongly indicated when:

A.The patient is edentulous

B.Future dental implant placement is planned and buccal plate integrity is compromised

C.The tooth was non-restorable due to caries only

D.Primary closure is achieved without graft

Explanation: After extraction, the buccal plate resorbs up to ~50% in the first year (especially horizontally). Ridge/socket preservation with particulate graft and membrane minimizes this resorption and is most beneficial when implant placement is planned and the buccal plate is thin or fenestrated.

6A palatal torus requires removal MOST appropriately when:

A.It is asymptomatic and stable

B.It interferes with fabrication or comfort of a complete maxillary denture

C.The patient has malocclusion

D.It is smaller than 1 cm

Explanation: Tori palatini and mandibulares are benign exostoses. Indications for removal are functional: interference with denture fabrication/seating, chronic mucosal ulceration over the torus, or impaired speech. Asymptomatic tori in dentate patients are left alone.

7Which of the following is the most common complication after mandibular third molar extraction?

A.Lingual nerve paresthesia

B.Alveolar osteitis (dry socket)

C.Mandibular fracture

D.Maxillary sinus exposure

Explanation: Alveolar osteitis occurs in 1–5% of routine extractions and up to 30% of impacted mandibular M3s. Risk factors: smoking, oral contraceptives, poor oral hygiene, traumatic extraction. Treatment is irrigation and medicated dressing (eugenol-based); it is self-limited but painful.

8The coronectomy (intentional partial root retention) technique is considered when:

A.The tooth has a periapical abscess

B.The roots are in intimate contact with the IAN and the tooth is vital and non-carious

C.The patient has osteomyelitis

D.The tooth is horizontally impacted and carious

Explanation: Coronectomy removes the crown while leaving vital, asymptomatic roots undisturbed, reducing IAN injury risk when high-risk radiographic signs are present. Contraindications: carious/infected tooth, mobile roots, horizontal impaction where the crown is below the IAN, or immunocompromise.

9Primary closure after mandibular third molar removal, compared with secondary intention healing, has been shown to:

A.Reduce the incidence of dry socket to zero

B.Increase postoperative swelling and trismus

C.Eliminate the need for antibiotics

D.Have no effect on healing

Explanation: Meta-analyses suggest primary (complete) closure modestly increases postoperative pain, swelling, and trismus compared with secondary-intention healing (leaving the distal aspect open), without significantly affecting dry socket incidence. Surgeon preference and flap design dictate the approach.

10An oroantral communication identified after extraction of a maxillary first molar measures 4 mm. The most appropriate management is:

A.Observation only

B.Gelfoam plus figure-of-eight suture and sinus precautions

C.Buccal advancement flap or buccal fat pad closure

D.Caldwell-Luc with packing

Explanation: OACs <2 mm often close spontaneously with observation and sinus precautions. Defects 2–6 mm can be managed with a figure-of-eight suture and Gelfoam. Defects >5 mm typically require flap closure — buccal advancement (Rehrmann), palatal rotation, or buccal fat pad — plus antibiotics and decongestants.

About the ABOMS Exam

The American Board of Oral and Maxillofacial Surgery (ABOMS) certification is a 2-part process comprising a Qualifying Examination (300+ single-best-answer MCQs) and an Oral Certifying Examination. Content spans maxillofacial trauma (Le Fort I/II/III, ZMC, NOE, mandibular fractures, panfacial sequencing), implantology (osseointegration, Misch D1-D4, sinus lift, GBR, zygomatic implants), dentoalveolar surgery (Pell & Gregory third molar classification, Rood & Shehab IAN risk signs, coronectomy), oral and maxillofacial pathology (OKC PTCH1, ameloblastoma BRAF V600E, fibro-osseous lesions, salivary gland tumors), oral cancer (SCC AJCC 8 with DOI/ENE, neck dissection levels I-V), orthognathic surgery (BSSO Obwegeser/Dal Pont/Hunsuck/Epker, Le Fort I, genioplasty, MMA for OSA), anesthesia and sedation (AAOMS parameters, airway, malignant hyperthermia), reconstructive surgery (fibula free flap, radial forearm, Brown and HCL defect classifications), TMJ (Wilkes, arthroscopy, total joint replacement), odontogenic infections (Ludwig angina, fascial spaces), pediatric OMFS and cleft lip/palate, and MRONJ (AAOMS 2022). Requires completion of a CODA-accredited 4-6 year OMFS residency.

Questions

300 scored questions

Time Limit

2-part certification — Qualifying Examination (1-day CBT with 300+ MCQs) + separate Oral Certifying Examination

Passing Score

Criterion-referenced scaled score set by ABOMS (modified Angoff standard)

Exam Fee

~$2,000-$3,000 combined Qualifying and Oral Certifying Examination fees (ABOMS 2026 — verify current schedule) (American Board of Oral and Maxillofacial Surgery (ABOMS) / Pearson VUE)

ABOMS Exam Content Outline

~13%

Maxillofacial Trauma

Le Fort I/II/III maxillary fractures, zygomaticomaxillary complex (ZMC), orbital floor blowout (entrapment, enophthalmos, diplopia), nasoorbitoethmoid (NOE) fractures, mandibular fractures (condylar, subcondylar, angle, body, parasymphysis, symphysis), AO/ASIF principles, MMF (arch bars, IMF screws, Erich, Ivy loops), ORIF, pediatric facial fractures, panfacial sequencing (bottom-up/outside-in), dentoalveolar trauma (Ellis classification, luxation, avulsion — replantation protocols).

~11%

Implantology

Osseointegration (Brånemark), Misch D1-D4 bone density classification, immediate vs delayed loading, Lekholm-Zarb bone quality, zygomatic implants (Aparicio), sinus lift (lateral window, Summers osteotome), socket preservation, guided bone regeneration (GBR), membrane selection (resorbable vs non-resorbable), All-on-4, implant failure (early vs late), peri-implantitis, maxillary sinus pneumatization, inferior alveolar nerve proximity, CBCT planning.

~10%

Dentoalveolar Surgery

Impacted third molars (Pell & Gregory class I/II/III, position A/B/C; Winter's angulation — mesioangular most common), IAN injury risk factors (Rood & Shehab signs — darkening of root, diversion of canal, interruption of white line), coronectomy, lingual nerve anatomy, dry socket (alveolar osteitis), oral-antral communication/fistula, exposure of impacted canines, odontogenic cyst and tumor enucleation, apicoectomy.

~10%

Oral and Maxillofacial Pathology

Odontogenic cysts (radicular/periapical, dentigerous, odontogenic keratocyst OKC — PTCH1, Gorlin/NBCCS), odontogenic tumors (ameloblastoma — conventional solid/multicystic vs unicystic vs peripheral; BRAF V600E; odontoma; adenomatoid odontogenic tumor; calcifying epithelial odontogenic tumor — Pindborg; cementoblastoma), fibro-osseous lesions (ossifying fibroma, fibrous dysplasia — GNAS/McCune-Albright, cemento-osseous dysplasia), giant cell lesions, mucoceles, ranula, salivary gland tumors (pleomorphic adenoma, Warthin, mucoepidermoid, adenoid cystic).

~10%

Oral Cancer & Head/Neck Oncology

Oral squamous cell carcinoma (AJCC 8 — depth of invasion DOI for T-staging, extranodal extension ENE for N-staging), premalignant lesions (leukoplakia, erythroplakia, oral submucous fibrosis, proliferative verrucous leukoplakia), HPV-associated oropharyngeal SCC (p16+), risk factors (tobacco, alcohol, betel quid), biopsy technique, neck dissection (radical, modified radical, selective — levels I-V), sentinel lymph node biopsy, adjuvant radiation/chemoradiation (cisplatin), field cancerization.

~10%

Orthognathic Surgery

Cephalometric analysis (SNA, SNB, ANB, Wits, occlusal plane), Angle classification (I/II/III malocclusion), Le Fort I maxillary osteotomy (advancement, impaction, setdown, segmentation), bilateral sagittal split osteotomy (BSSO — Obwegeser/Dal Pont/Hunsuck/Epker modifications; bad splits), intraoral vertical ramus osteotomy (IVRO), genioplasty (sliding, augmentation, reduction), maxillomandibular advancement (MMA) for OSA, distraction osteogenesis, virtual surgical planning (VSP), CAD/CAM splints.

~9%

Anesthesia & Sedation

Office-based anesthesia (AAOMS parameters of care), minimal/moderate/deep sedation continuum, general anesthesia, propofol/midazolam/fentanyl/ketamine pharmacology, nitrous oxide, airway management (Mallampati, LEMON, ASA physical status), difficult airway algorithm, nasotracheal intubation, laryngospasm, malignant hyperthermia (dantrolene), local anesthetic toxicity (lipid emulsion 20% — Intralipid), bupivacaine cardiotoxicity, methemoglobinemia (prilocaine/benzocaine), reversal agents (flumazenil, naloxone).

~9%

Reconstructive Surgery

Mandibular and maxillary reconstruction, free tissue transfer — fibula free flap (workhorse for mandibular defects, up to 25 cm bone, septocutaneous skin paddle), radial forearm free flap (RFFF — thin pliable soft tissue), anterolateral thigh (ALT), scapular/parascapular, iliac crest (DCIA), composite defects (Brown classification maxillary, Jewer/Boyd HCL mandibular), pedicled flaps (pectoralis major, temporalis, submental island), nerve repair (inferior alveolar, lingual; direct, grafts — sural, great auricular, processed allograft), virtual planning with cutting guides.

~6%

Temporomandibular Joint (TMJ)

TMJ anatomy and biomechanics, internal derangement (Wilkes classification I-V), disc displacement with/without reduction, osteoarthritis, ankylosis, MRI evaluation, arthrocentesis, arthroscopy, open arthroplasty, discectomy with/without replacement, total joint replacement (stock vs custom prostheses — TMJ Concepts, Zimmer Biomet), idiopathic condylar resorption, juvenile idiopathic arthritis, condylar hyperplasia (Obwegeser classification; technetium bone scan).

~5%

Odontogenic Infections

Fascial space anatomy (submandibular, submental, sublingual, buccal, canine, masticator, pterygomandibular, parapharyngeal, retropharyngeal, danger space, mediastinum), Ludwig angina (bilateral submandibular + sublingual + submental — airway emergency), descending necrotizing mediastinitis, odontogenic source identification, incision and drainage, antibiotic selection (penicillin + metronidazole, clindamycin, ampicillin-sulbactam), cavernous sinus thrombosis, osteomyelitis (acute, chronic, Garré proliferative periostitis).

~4%

Pediatric OMFS & Cleft

Cleft lip (Millard rotation-advancement, Tennison-Randall), cleft palate (Furlow double-opposing Z, von Langenbeck, two-flap), alveolar bone grafting (mixed dentition, iliac crest), velopharyngeal insufficiency (pharyngeal flap, sphincter pharyngoplasty), pediatric facial fractures (greenstick, guarded ORIF due to growth centers), Pierre Robin sequence (mandibular distraction), craniofacial syndromes (Crouzon/Apert FGFR2, Treacher Collins TCOF1), ankyloglossia, supernumerary and natal teeth.

~3%

Ethics, Safety & MRONJ

MRONJ (medication-related osteonecrosis of the jaw — AAOMS 2022 position paper staging 0-3; bisphosphonates, denosumab, anti-angiogenics; prevention with dental clearance before therapy; drug holiday controversy), osteoradionecrosis (Marx staging, pentoxifylline + tocopherol ± clodronate — PENTOCLO, HBO), informed consent, surgical time-out, WHO checklist, biostatistics (sensitivity/specificity, PPV/NPV), VTE prophylaxis.

How to Pass the ABOMS Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABOMS (modified Angoff standard)
Exam length: 300 questions
Time limit: 2-part certification — Qualifying Examination (1-day CBT with 300+ MCQs) + separate Oral Certifying Examination
Exam fee: ~$2,000-$3,000 combined Qualifying and Oral Certifying Examination fees (ABOMS 2026 — verify current schedule)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABOMS Study Tips from Top Performers

1Memorize Pell & Gregory third molar classification and Rood & Shehab signs: Pell & Gregory uses depth relative to occlusal plane (A/B/C — level with, between, below CEJ of second molar) and ramus relationship (Class I/II/III — distal to ramus, partially in ramus, completely in ramus). Rood & Shehab radiographic signs of IAN proximity include darkening of the root, deflection of the root, narrowing of the root, diversion of the canal, narrowing of the canal, and interruption of the white line — any of these increase IAN injury risk and warrant CBCT ± coronectomy consideration.

2Le Fort fractures — high-yield anatomy: Le Fort I (horizontal, separates palate/alveolus from midface, crosses pterygoid plates — 'floating palate'), Le Fort II (pyramidal, through nasofrontal suture, orbital floor, inferior orbital rim, anterior maxillary wall, pterygoid plates — 'floating maxilla'), Le Fort III (craniofacial dysjunction — through nasofrontal suture, frontozygomatic suture, zygomatic arch, pterygoid plates — 'floating face'). All Le Fort fractures by definition involve the pterygoid plates.

3BSSO (bilateral sagittal split osteotomy) modifications and bad splits: Obwegeser original technique; Dal Pont added the buccal cut to the second molar region to increase bony overlap; Hunsuck limited the medial cut to just past the lingula (less dissection, lower risk); Epker added subperiosteal dissection and reduced medial cut. Bad splits — most common is buccal plate fracture of the proximal segment; others include lingual plate fracture of the distal segment and unfavorable condylar splits. Risk factors for bad split include impacted third molars (ideally remove 6-9 months before BSSO).

4MRONJ (AAOMS 2022 Position Paper) staging: Stage 0 — nonspecific symptoms, no clinical/radiographic evidence of necrotic bone. Stage 1 — exposed/necrotic bone or fistula, asymptomatic, no infection. Stage 2 — exposed bone with infection/pain. Stage 3 — exposed bone with pathologic fracture, extraoral fistula, oral-antral/oral-nasal communication, or osteolysis extending to inferior border. Prevention is key: dental clearance BEFORE starting bisphosphonates/denosumab/anti-angiogenics; avoid extractions during high-risk therapy when possible.

5Oral SCC AJCC 8 management pearls: New in AJCC 8 — depth of invasion (DOI) drives T-staging (T1 ≤2 cm AND DOI ≤5 mm; T2 ≤2 cm AND DOI 5-10 mm or 2-4 cm AND DOI ≤10 mm; T3 >4 cm OR DOI >10 mm; T4a through cortical bone, maxillary sinus, skin). Extranodal extension (ENE) upstages N (any ENE+ is at least N2a for single ipsilateral node). Neck levels I-V — elective neck dissection (selective I-III supraomohyoid) for DOI >4 mm or clinically node-negative T2+. Adjuvant radiation for close margins, PNI, LVI, multiple nodes; add cisplatin for positive margins or ENE.

Frequently Asked Questions

What is the ABOMS certification process?

The American Board of Oral and Maxillofacial Surgery (ABOMS) certification is a 2-part process. Part 1 is the Qualifying Examination — a 1-day computer-based test with 300+ single-best-answer MCQs covering the breadth of OMFS practice. Part 2 is the Oral Certifying Examination — a separate structured oral assessment in which candidates manage clinical cases with expert examiners. Both must be passed for initial board certification.

Who is eligible to take the ABOMS Qualifying Examination?

Candidates must complete a CODA-accredited Oral and Maxillofacial Surgery residency — either a 4-year single-degree pathway (D.D.S./D.M.D.) or a 6-year dual-degree pathway (D.D.S./D.M.D. + M.D.). A valid unrestricted dental (and medical, if applicable) license is required, and the program director must attest to satisfactory performance and ethics during residency.

What is the format of the ABOMS Qualifying Examination?

The Qualifying Examination is a 1-day computer-based examination administered at Pearson VUE test centers, comprising 300+ single-best-answer multiple-choice questions. Items commonly include clinical photographs, panoramic and CBCT imaging, cephalometric tracings, and intraoperative images. The exam is blueprinted to the ABOMS content outline spanning trauma, implants, dentoalveolar, pathology, oncology, orthognathic, anesthesia, reconstruction, TMJ, infections, and pediatric OMFS.

How much does the 2026 ABOMS exam cost?

Combined 2026 ABOMS Qualifying and Oral Certifying Examination fees are approximately $2,000-$3,000 — always verify the current schedule on the ABOMS website. Cancellation and refund policies follow the ABOMS schedule with decreasing refunds as the exam date approaches. Retakes require re-registration and full fee payment within the allowed qualification window.

When are the ABOMS exams administered?

The ABOMS Qualifying Examination is typically offered in the spring, with applications opening the preceding fall. The Oral Certifying Examination is administered separately, generally later in the year following successful completion of the Qualifying Examination. Candidates schedule specific Qualifying Examination appointments with Pearson VUE after application approval. Exact 2026 dates should be confirmed on the ABOMS website.

How is the exam scored?

ABOMS uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance relative to the fixed cut-score, not on other candidates. Score reports include domain-level feedback. Candidates must pass the Qualifying Examination before becoming eligible for the Oral Certifying Examination.

What are the highest-yield topics?

Highest-yield topics include Pell & Gregory third molar classification and Rood & Shehab IAN risk signs, Misch D1-D4 bone density and implant osseointegration, Le Fort I/II/III fracture patterns, BSSO and Le Fort I orthognathic technique (Obwegeser/Dal Pont/Hunsuck/Epker), ameloblastoma (BRAF V600E) and OKC (PTCH1) management, oral SCC AJCC 8 with DOI and ENE, fibula free flap for mandibular reconstruction, Wilkes TMJ classification, Ludwig angina and fascial space anatomy, and MRONJ AAOMS 2022 staging.

How should I study for this exam?

Use a structured 12-18 month plan layered on residency. Map to the ABOMS content outline: begin with dentoalveolar, implants, and anesthesia, then trauma, orthognathic, and TMJ, then pathology, oral cancer, and reconstruction, and finish with infections, MRONJ, cleft, and ethics. Integrate core textbooks (Peterson's Principles of OMFS, Miloro Principles of OMFS, Fonseca Oral and Maxillofacial Surgery), In-Service exam questions, and high-volume MCQ practice. Complete 2-3 full-length timed mock exams. Drill panoramic/CBCT interpretation, cephalometric analysis, and clinical photograph recognition.