Module 12: perio probes and basic probing technique

what is the design of a perio probe?

it has a blunt, rod-shaped working end that may be circular or rectangular in cross section and is calibrated with mm markings

T/F: the working end and the shank of a perio probe meet in a defined angle that is usually less than 90 degrees

false - great than 90 degrees

what is the primary function of a perio probe?

• to detect perio pockets to determine the health status of the periodontium

• used to obtain a physical measurement of the distance between the gingival margin and the base of a periodontal pocket

what is the most important clinical tool for obtaining information about the health status of the periodontium?

perio probe

what are the other functions of a perio probe in addition to measuring perio pocket depths?

• measure CAL

• measure extent of recession of gingival margin

• measure width of attached gingiva

• measure size of intraoral lesions

• assess BOP

• determine mucogingival relationships

• monitoring the longitudinal response of the periodontium to tx

T/F: all perio probes are made of stainless steel

false - most are made of stainless steel, some are made of titanium or plastic

what are the different types of mm markings that could be on a perio probe?

grooves, colored indentations, or colored bands

what is the gingival sulcus defined as anatomically?

distance from the gingival margin to the coronal most part of the JE

where do probing depths exhibit the least depth?

facial surfaces

T/F: probing depths on the mesial and distal surfaces are slightly deeper than the depths of the lingual surfaces

true

what is periodontitis?

a bacterial infection of all parts of the periodontium including the gingiva, periodontal ligament, alveolar bone, and cementum

how is periodontitis identified clinically?

by the presence of a periodontal pocket (a sulcus >3mm)

what is a periodontal pocket?

a gingival sulcus that has been deepened by disease; results from destruction of alveolar bone and the periodontal ligament fibers that surround the tooth

in a periodontal pocket, where does the JE form?

at the base of the pocket by attaching to the root surface somewhere apical to the CEJ

what is a gingival pocket?

a deepening of the gingival sulcus

what causes the increased probing depth seen in a gingival pocket?

it is due to (1) detachment of the coronal portion of the JE from the tooth and (2) increased tissue size due to swelling of the tissue

what is a pseudo-pocket?

when the gingival tissues swells resulting in an increased probing depth in some gingivitis cases

what does a periodontal pocket result from?

(1) apical migration of the JE and (2) destruction of the periodontal ligament fibers and alveolar bone

where do junctional epithelial cells attach in periodontitis?

to the cememtum of the root

what are some of the limitations of probing measurements?

position of the gingival margin, reading errors due to naturally occurring states, and reading errors due to probing technique and equipment

how does the position of the gingival margin affect probing depth?

if the gingival margin is not in its normal location, the probing depths will not accurately reflect the health of the periodontium

how is probing depth affected if the gingival margin is significantly coronal to the CEJ? i.e. swollen or overgrown due to gingivitis or drug therapy

the extent of periodontal destruction is overestimated since the gingival margin is coronal to its normal position

how is probing depth affected if the gingival margin is apical to the CEJ?

in situations where recession of the gingival margin is present, probing depth readings can substantially underestimate the true extent of periodontal destruction

What are some naturally occurring states that may cause reading errors?

interference from calculus deposits on the tooth surface, the presence of an overhanging restoration, or the crown’s contour

what are some technique errors that may cause reading errors?

incorrect angulation and positioning of the probe, incorrect amount of pressure applied to the probe, misreading the probe calibrations, and recording the measurements incorrectly

what are other variables that influence measurements?

diameter and shape of the probe, calibration scale of the probe, and the degree of inflammation in the periodontal tissues

T/F: manufacturing errors can result in the widths of probe markings differing by as much as 0.7mm between probes

true

how is the working end aligned once the probe is inserted into the pocket?

kept parallel to the root surface

how should proximal surfaces be probed?

from both the facial and lingual aspects to assure that the entire circumference of the JE is assessed

what is the two step technique used to probe a proximal surface?

1. keeping the working end of the probe in contact with the proximal root surface, walk the probe across the proximal surface until it touches the contact area

2. slant the probe slightly so that the tip reaches under the contact area. the tip of the prob extends under the contact area while the upper portion touches the contact area.

3. with the prob in this position, gently press downward to touch the JE

what is the walking stroke?

• the movement of a calibrated probe around the perimeter of the base of a sulcus or pocket

• used to cover the entire circumference of the sulcus or pocket

why is it essential to evaluate the entire circumference of the pocket base?

because the JE is not necessarily at a uniform depth from the gingival margin

T/F: it is not common for 2 neighboring sites along the pocket base to have differences in depths

false - it is common

what does informed consent involve?

it not only involves informing the patient about the expected successful outcomes of periodontal instrumentation, but also the possible risks, unanticipated outcomes, and alternative tx as well

what are some ethical considerations for informed consent for the patient?

• reasons/importance

• expected outcomes

• risks involved

• possible unexpected results

• alternative approaches

• possible consequences of refusal of tx

• costs of proposed tx and alternatives

• patient’s capacity to consent (age, mental, language comprehension)

• written consent by patient