Module 18: Advanced probing techniques

to remain in the oral cavity, each tooth must be attached by:

junctional epithelium, fibers of the gingiva, periodontal ligament fibers, and alveolar bone

what is loss of attachment in periodontitis characterized by?

relocation of the JE to the tooth root, destruction of the fibers of the gingiva, destruction of the periodontal ligament fibers, and loss of alveolar bone support from around the tooth

what do attachment structures look like in health?

• JE attached to enamel at base of sulcus

• fibers brace the tissue against the crown

• may fibers attach root to bone of socket

• most of the root is surrounded by bone; tooth is firmly held in its socket

what do attach structures look like in disease?

• JE attaches to cementum at base of perio pocket

• fiber destruction, tissue lacks firmness

• fewer fibers remain to hold tooth in socket

• part of the root is surrounded by bone; tooth may be movable in its socket

Describe bone support in health

most of root surrounded by bone. the crest of the alveolar bone is located very close to the crowns, only 1-2mm apical to the CEJs of the teeth

describe bone support in gingivitis

no loss of alveolar bone and the crest of the alveolar bone remains only 1-2mm apical to the CEJs of the teeth

describe bone loss in periodontitis

bone is destroyed and the teeth are not well supported in the arch.

what clinical features are normally included in a comprehensive perio assessment?

probing depth measurements, BOP, presence of exudate, level of FGM and MGK, tooth mobility, furcation involvement, presence of calculus and plaque biofilm, gingival inflammation, radiographic evidence of alveolar bone loss, and presence of local contributing factors

How are perio probes used in the assessment of intraoral lesions?

measurement of the size of pathologic lesions

How are perio probes used in the assessment of BOP?

bleeding on gentle probing indicates gingival inflammation

How are perio probes used in the assessment of recession of the gingival margin?

• measurement from the free gingival margin to the CEJ

• a clinical indicator of loss of attachment

How are perio probes used in the assessment of amount of attached gingiva?

determination of the width of the attached gingiva (the part of the gingiva that is tightly connected to the cementum on the cervical third of the root and to the periosteum of the alveolar bone)

How are perio probes used in the assessment of probing depth?

measurement from FGM to the base of the sulcus or perio pocket; deepest reading is recorded for each of six zones per tooth

How are perio probes used in the assessment of clinical attachment level?

• measurement from the CEJ to the base of the sulcus or perio pocket

• measure from a fixed point (the CEJ) more accurately reflects the true extent of bone support, especially when recession of the FGM is present

How are perio probes used in the assessment of distance between teeth?

measurement of distances between teeth or migration of teeth with severe perio disease

How are perio probes used in the assessment of furcation involvement?

detection of bone loss between the roots of multirooted teeth

what information should be recorded when an oral lesion is observed?

date, size, location, color, character of the lesion, and any information provided by the pt (i.e. duration, sensation, or oral habits)

T/F: it is best to use anatomic references, rather than length or width, to document your measurements

true - i.e. the anterior-posterior measurement

how do you determine the height of a raised lesion?

place the probe tip on normal tissue alongside of the deviation

how do you determine the depth of a sunken lesion?

carefully place the probe tip in the deepest part

T/F: all teeth have a normal physiological tooth movement of 1 mm due to the PDL

false- 0.5mm

what is class 1 mobility?

slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction

what is class 2 mobility?

moderate mobility, greater than 1 mm but less than 2 mm of horizontal displacement in a facial-lingual direction

what is class 3 mobility?

severe mobility, greater than 2 mm of displacement in a facial-lingual direction or vertical displacement

when does BOP occur?

either immediately after the site is probed or slightly delayed

what may cause the position of the gingival margin to be significantly coronal to the CEJ?

swelling, an overgrowth of the gingival tissues caused by certain medications that a pt takes to treat a medical condition, and/or an increase in the fibrous connective tissue of the gingiva due to a long-standing inflammation of the tissue

what is the clinical attachment level?

• clinical measure of the true perio support around the tooth as measured with a perio probe

• provides an estimate of a tooth’s stability and the loss of bone support

what is the significance of clinical attachment levels?

an attachment level measurement is a more accurate indicator of the perio support around a tooth than is a probing depth measurement

T/F: probing depths alone are reliable indicators of the amount of perio support for a tooth

false - are not reliable indicators

T/F: clinical attachment levels are the preferred and more accurate indicator of the actual amount of perio support for a tooth

true - they are measured from a fixed point (CEJ)

what is a critical factor in distinguishing between gingivitis and periodontitis?

the presence of loss of attachment

• inflammation with no attachment loss = gingivitis

• inflammation with attachment loss = periodontitis

what is the root trunk?

the area of a multirooted tooth that extends from the CEJ to the entrance of the furcation

what is furcation involvement?

loss of alveolar bone and PDL fibers in the space between the roots of a multirooted tooth

when does furcation involvement occur?

when periodontal infection invades the area between and around the roots, resulting in loss of attachment and loss of alveolar bone between the roots of the teeth

T/F: the entrance to the furcation area of a molar tooth can vary greatly in size due to the varying degrees of separation of the roots

true

T/F: furcation involvement occurs 3x more frequently among mandibular molars than maxillary molars

false - more frequently among maxillary molars than mandibular molars

T/F: furcation involvement was detected more frequently in maxillary molars by radiographic examination than by clinical examination

true - opposite for mandibular molars

what are furcation arrows?

small triangular radiographic shadows; when radiographs of max molars are observed, a small triangular radiographic shadow pointing toward the furcation is sometimes noted over either the mesial or distal roots in the proximal furcation area

what is the design of a furcation probe?

curved, blunt tipped working ends that allow easy access to the furcation areas

what is grade I furcation?

• curvature of the concavity, just above the furcation entrance, on the root trunk can be felt with the probe tip

• probe penetrates the furcation no more than 1 mm

what is grade II furcation?

probe penetrates into the furcation greater than 1 mm (extending approximately 1/3 of the width of the tooth) but is not able to pass completely through the furcation

what is grade III furcation?

mandib molars - probe passes completely through the furcation between the mesial and distal roots

max molars - probe passes between the MB and DB roots and touches the palatal root

what is grade IV furcation?

same as grade III except that the entrance to the furcation area is visible clinically due to recession of the gingival margin