MODULE 5: Periodontal Diagnostic Procedures

Probe Position in Healthy Tissue

-A healthy sulcus is 1 to 3 mm in depth. -The probe tip touches the tooth near the CEJ.

Glickman's Furcation Classification - Class 1

-Concavity can be felt with probe -Probe tip cannot enter the furcation area

Proximal Surface Assessed from Facial and Lingual - Step 1

-Insert at the distofacial line angle. -Keep the side of the probe in contact with the tooth surface. -Gently slide to touch the soft tissue base.

Probe Walking Stroke

-Insert the probe and lightly run the tip along the tooth surface until it encounters the soft tissue base of the sulcus or pocket. -The junctional epithelium that forms the base of a sulcus or pocket feels soft and flexible when touched with the probe tip.

Proximal Surface Assessed from Facial and Lingual - Step 2

-Keep the tip in contact with the tooth, pressing down to touch the soft tissue base. -Initiate a series of short, walking strokes toward the distal surface.

Glickman's Furcation Classification - Class 3

-Mandibular molars- probe passes completely through the furcation -Maxillary molars- probe touches the palatal (lingual) root

Limitations of Measurements

-Position of gingival margin -Interference from calculus deposits, overhanging restorations -Amount of pressure applied -Misread probe calibrations

Probe in a Healthy Sulcus

-Probe inserted into a healthy gingival sulcus -In health, the probing depth should be from 1 mm to 3 mm in depth.

Glickman's Furcation Classification - Class 2

-Probe tip can partially enter the furcation -Extends about one-third of the tooth -NOT able to pass completely through

Formula for Bleeding Index

-The number of sites where bleeding is recorded is divided by the total number of available sites in the mouth to express bleeding index as a percentage.

CALCULATING A BLEEDING INDEX

-The number of sites where bleeding is recorded is divided by the total number of possible sites in the mouth to express bleeding index as a percentage. Incipient Gingivitis ˂10% BOP Localized Gingivitis 10-30% BOP Generalized Gingivitis >30% BOP -A stable GI is ≤ 10%

Proximal Surface Assessed from Facial and Lingual - Step 4

-Tilt the probe so that the tip reaches beneath the contact area. -Gently press downward to touch the soft tissue base of the sulcus/pocket.

Continuous Walking Stroke

-Walking strokes used to cover the entire circumference of sulcus -The junctional epithelium is not always a uniform depth

Proximal Surface Assessed from Facial and Lingual - Step 3

-uWalk the probe onto the distal surface until it touches the contact area.

The Probe tip is _____ to ______ mm of the side of the probe

1 to 2

FULCRUM & ASSESSMENT STROKE

1.Rocking on your fulcrum finger side to side, NOT forward and backwards. 2.Explorer tip will naturally move up and down as you rock on fulcrum finger. This is your assessment stroke. 3.Keeping the first 1-2mm of the working end on the surface of the spool. 4.Rotate the handle at the same time of performing your assessment stroke. 5.Continue this around entire spool. Moving tip up and down and moving forward at the same time.

Why do we need a bleeding index?

A bleeding index (BI), based on bleeding upon probing (BoP) assesses the presence, and severity or absence of gingival inflammation.

Furcation Probes

A furcation probe is a type of periodontal probe used to evaluate the bone support in the furcation areas of multirooted teeth.

Probe in Periodontal Pocket

A probing depth deeper than 3 mm indicates a periodontal pocket.

Walking Stroke

A series of walking or tapping strokes that are made within the sulcus or pocket while keeping the probe tip against the tooth surface.

A furcation that is detectable and the probe is able to advance 1-2mm into the furca would be considered Class II Class I Class III

Class II

PARALLELISM

Correct: Probe Parallel to Long Axis This probe is correctly positioned parallel to the long axis of the root surface.

Record the __________ Measurement

Deepest -In this example, the deepest reading would be recorded for the facial reading. -That reading is the one taken at point C.

Glickman's Furcation Classification

Glickman's Furcation Classification

Tooth Mobility

Measurement of the movement of the tooth in its socket

Probing Depth

Measuring the Sulcus or Periodontal Pocket With a Probe

How to Classify Tooth Mobility?

Miller's Mobility Index: ´Class I = 1st distinguishable sign of movement greater than normal ´Class II = movement of the crown by up to 1 mm in any direction ´Class III = movement of crown greater 1mm and/or vertical depression or rotation

Begin with ____, chart as indicated

PSR

When probing, all of the following are correct EXCEPT one, which is the EXCEPTION? Probe should be kept parallel to long axis of the tooth except at the most IP area Six sites are recorded for each tooth Probe should not be placed apical to the contact Walking motion is used to advance the probe

Probe should not be placed apical to the contact Six sites are recorded for each tooth. Probe should be kept parallel to the long axis of the tooth except for at the most interproximal area of the tooth where the probe must be angled under the contact point into the col area. The probe is advanced with a walking motion within the sulcus.

Probe Position in Pocket

Probe tip touches the root somewhere below the CEJ Probing depth is greater than 3 mm

Full periodontal chart includes:

Probing Depths with bleeding points, measurement of Free Gingival Margin, Mobility and Furcation measurements.

Utilizing a modified pen grasp, which finger is used as your fulcrum? Middle finger Ring finger Index finger

Ring finger

Probing:

The act of walking the tip of a probe along the base of a sulcus or pocket for the purpose of assessing the health status of the periodontal tissues

Clinically Visible Furcation

The furcation of this molar is visible in the mouth due to bone loss and tissue recession.

CORRECT Adaptation of Probe Tip

The probe tip is kept in contact with the tooth surface throughout the walking stroke.

INCORRECT Adaptation of Probe Tip

The probe tip should NOT be held away from the tooth.

Taking readings on the mesial and distal surfaces - Step 2

Tilt the Probe -Slant the probe slightly so that the tip reaches under the contact area. -In this position, gently press downward to touch the soft tissue base.

Purpose of Identifying the Mobility of teeth

To determine: •if the tooth can be saved through scaling and root planning or needs to be extracted (Class III has a poor prognosis), •is mobility due to bone loss, fremitus, an endodontic or internal resorption etc. •to evaluate reduced mobility after periodontal and/or surgical therapy.

Taking readings on the mesial and distal surfaces - Step 1

Touch the Contact Area -Walk the probe between the teeth until it touches the contact area.

The F of tooth #3 (RH) or F of tooth #14 (LH) is considered a surface __________________ you? Towards Away

Towards

When using the 11/12 explorer on an anterior tooth, the elbow of the instrument should be correctly angled _________________ the tooth. Towards Away

Towards

The periodontal probe is ...

a periodontal instrument that is calibrated in millimeter increments and used to evaluate the health of the periodontal tissues.

In health, the furcation area ...

cannot be probed because it is filled with bone and periodontal ligament fibers.

Maxillary Molars: Buccal - Enter furcation between the

distobuccal and mesiobuccal roots from the facial aspect

Maxillary Molars: Mesial - Access mesial proximal furcation ...

from lingual aspect

Maxillary Molars: Distal - Access furcation on distal proximal

from lingual aspect -Furcation probe wraps around palatal root to enter furcation

If a full chart completed in the past, then ...

full perio chart indicated going forward

Probing Depth - The distance in millimeters from the

gingival margin to the base of the sulcus or periodontal pocket as measured with a probe

Most furcation involvement is ...

hidden from view by the gingival tissues and must be located with a probe.

Maxillary Molars: Distal - Access distal proximal furcation from ...

lingual aspect

Furcation involvement detected more frequently in _______ molars by clinical exam than by radiographs.

mandibular

Studies indicate furcation involvement detected more frequently in _______ molars by radiographs than by clinical exam.

maxillary

Furcation area of mandibular molars located between ...

mesial and distal roots

•Every patient seen at Roseman COD should receive an updated periodontal diagnosis every ...

six months

Probing depths help determine ...

the periodontal diagnosis and treatment planning.

Furcation Measurements aid in the determination of

treatment and prognosis.

Gingival Sulcus

uThe v-shaped space between the free gingiva and the tooth surface uA periodontal probe is inserted into this space to assess its health.

TREATMENT RECOMMENDATIONS FOR GINGIVAL BLEEDING AND INFLAMMATION

• Clear and concise oral hygiene instruction • Increased patient motivation for adequate home care • Professional mechanical plaque removal and antimicrobial/anti-inflammatory oral care products • When needed: dietary advice and tobacco counselling are strongly recommended

UNC-15 Probe Design Characteristics

• Preferred probe for use in clinical research • Millimeter markings are at each millimeter • UNC-15 color-coded bands are at 4-5, 9-10, and 14-15 mm markings • Thin, round working-end

What is the FGM?

• The free gingival margin is the area located between the sulcular epithelium and the epithelium of the oral cavity. This interface exists at the most coronal point of the gingiva, which is also known as the crest of the marginal gingiva.

Furcation Involvement

•A furcation is the place on a multirooted tooth where the root trunk divides into separate roots. •Furcation involvement is a loss of alveolar bone and periodontal ligament fibers in the space between the roots of a multirooted tooth.

What do the numbers mean? FGM

•A normal, healthy FGM measurement for the whole facial or lingual surface of a tooth is: -3 -2 -3 •This means that the gingival margin is -3-2-3 mm's above the CEJ •So a reading of 1, 2, 1 means that the gingival margin is 1, 2, 1 mm's below the CEJ

Advantages to using correct clock positioning

•Better visibility to perform dental procedures •Better leverage to remove calculus deposit •Easier to find an effective fulcrum •Better patient management •Improved ergonomics

Is the FGM the same as recession?

•Don't think of the FGM as measuring recession. •We measure the FGM to help calculate the clinical attachment level (CAL) •Calculating the cAL helps us to make a proper periodontal diagnosis.

MARQUIS Probe Design Characteristics

•Marked in bands with each band being several mm in width •Millimeters markings are at every 3 mm. •The millimeter markings are at 3, 6, 9 and 12 mm.

SIGNS OF GINGIVAL INFLAMMATION DUE TO BLEEDING

•Mild inflammation, slight color change and edema, little to no bleeding. •Moderate inflammation, redness, edema, continuous more bleeding on probing. •Severe inflammation, marked redness and edema ulceration, spontaneous bleeding on probing.

Etiology of Mobility of the teeth

•Periodontal disease •Traumatic occlusion •Injury •Bruxium (clenching and grinding) •Pregnancy •Osteoporosis •Orthodontic treatment

MODIFYING RISK FACTORS FOR BLEEDING

•Prominent subgingival restorations •Hyposalivation •Xerostomia, •Medications •Systemic diseases •Smoking •Poor oral hygiene According to the AAP new classification: oral contraceptives and menstrual cycle have been removed as a modifying risk factor for gingival inflammation!

How do I measure the FGM?

•The CEJ is your reference point. •The CEJ is "Ground zero" so to speak. •The CEJ is 0 •A measurement of the gingival margin above the CEJ is a negative number. •A measurement of the gingival margin below the CEJ is a positive number. •You measure six surfaces per tooth: Distal facial, straight facial, mesial facial, distal lingual, straight lingual, and mesial lingual.

PSR Probe Design Characteristics

•The PSR system is unique in the way the probe is read. The clinician need only observe the position of the color-coded band in relation to the gingival margin on a PSR probe. •The PSR probe is initially used for periodontal screening and if warranted you will use the UNC periodontal probe for exact probing depths to determine periodontal disease. •Ball-tipped end helps avoid puncturing the epithelial attachment during probing.

Where is the FGM?

•The gingival margin (F) is the most coronal point of the gingiva. It is depicted as the top of the pink hill in the diagram to the right. The sulcular epithelium within the gingival sulcus (G) is located to the left, and the oral epithelium (E) is to the right.