periodontal probes

KRUPESH RAJANI

PERIODONTAL PROBES

Index

IntroductionHistoryStandard Periodontal ProbeClassificationTypes of Periodontal ProbeProbing techniqueWhen to probePocket probingThermal ProbePressure Sensitive Probe

18/03/2010Periodontal Probes

2

Index

NIDCR CriteriaFlorida Probing SystemFlorida Probing System for assessment of Clinical

Attachment Levels (CAL)Periimplant ProbingConclusionReferences


3

Introduction

Periodontal probes are used to locate, measure, and mark pockets, as well as determine their course on individual tooth surfaces.

Periodontal probes are used to measure the depth of pockets and to determine their configuration.

Periodontal Probes

4

18/03/2010

History

The third edition of G.V.Black’s Special Dental Pathology published in 1924 after his death mentions “the use of very thin flat explorers to “the use of very thin flat explorers to determine the depth of pockets”. determine the depth of pockets”. These instruments were not calibrated and they were not used for decades.

Periodontal probe and its use was first described by F.V. Simoton of the University Of California, San Francisco in 1925.


5

History

Simoton refers the periodontal probe as a “Periodontiometer” and credits W.H.Hamford and C.O.Patten for its invention.

Acceptance of routine periodontal probing in diagnosis was slow. Periodontal books published in 1930s makes brief mention of probes and probing, and the charts they proposed had no space for “pocket depth recordings”.


6

Standard Periodontal Probe7

Periodontal Probes

•The typical probe is a tapered, rod-like instrument calibrated in millimeters, with a blunt rounded tip.

18/03/2010

Classification

Periodontal probes may be divided into:First generation probes are conventional, and hand held probes, e.g. conventional periodontal

probes.Second generation probes are pressure –sensitive

probes. It has been shown that, with forces up to 30gms the probe tip remains within junctional epithelium and forces up to 50gms are necessary to diagnose osseous defects. This probe did solve many problems of the conventional probes, but lacked tactile sensitivity.

Periodontal Probes

8

18/03/2010

Classification

Third generation probes are computerized probes. Gibbs et al designed Florida probe. E.g.-Foster Miller Probe, Toronto Automated Probes, which can detect the cemento-enamel junction.

Fourth generation probes are the three dimensional probes in which sequential probe positions are measured.

Fifth generation probes are ultrasonographic probes which provides painless probing to the patient. The guidance path is predetermined in these probes.

Periodontal Probes

9

18/03/2010

Types Of Periodontal Probes

There are three types of periodontal probes. They are:1. Calibrated periodontal probes2. Naber’s furcation probe3. Computer assisted probes

Periodontal Probes

10

18/03/2010

Explorers


11

An explorer is an assessment instrument with a flexible wire like working-end.

Assessment instruments like periodontal probes and explorers are used to determine health of periodontal tissues, tooth anatomy, and texture of tooth surfaces.

Explorers

Design of explorers: 1. Explorers are made up of flexible metal that conducts vibrations from the working end to the clinician’s fingers on instrument shank and handle.2. Circular in cross-section.3. Working end is 1-2mm in length and is referred to as the explorer tip.4. The actual point of the explorer is not used to detect the calculus, rather the side of the explorer tip is applied to the tooth surface.


12

Explorers

Function of explorers:1. Explorers are used to detect, by tactile means, the texture and character of tooth surfaces, before, during and after periodontal debridement to assess the progress and completeness of instrumentation.

2. Explorers are used to examine tooth surfaces for calculus, decalcified and carious lesions, dental anomalies, and anatomic features such as grooves, curvatures, or root furcations.


13

Types Of Calibrated Periodontal Probes

Marquis color-coded probeUNC-15 probeUniversity of Michigan ‘O’ probe, with Williams markingsMichigan ‘O’ probeWorld Health Organization (WHO) probeNaber’s Furcation Probe

Calibrated probes have blunt, rod shaped working ends that may be circular or rectangular in cross-section.

14

Periodontal Probes 18/03/2010

Marquis Color-Coded Probe

Calibrations are in 3mm sections, markings are 3,6,9,12mm.


15

The UNC-15 Probe

• 15mm long and markings are at each mm and coding at the 5th,10th and 15thmm.

• Millimeter markings at 1,2,3,4,5,6,7,8,9,10,11,12,13,14 and 15 millimeters.


16

The University Of Michigan ‘O’ Probe With Williams Markings

Markings include 1,2,3,5,7,8 and 9mm with 4mm and 6mm missing.


17

Michigan ‘O’ Probe

Markings are at 3, 6, and 8mm.


18

WHO Probe

Prescribed in 1978.The probe was designed for two purposes:

-Measurement of pocket depth.-Detection of sub gingival calculus.

Used in the assessment of CPITN (Community Periodontal Index for Treatment Needs)

Weight = 5 gm.


19

WHO Probe


20

WHO Probe

Two variants of WHO Probes are available: CPITN-E Probe (Epidemiological Probe)

Markings at 3.5 and 5.5mm. CPITN-C Probe(Clinical Probe)

Markings at 3.5, 5.5, 8.5 and 11.5mm.These additional lines may be of use when performing a detailed assessment and recording of deep pockets for the purpose of preparing treatment plan for complex periodontal therapy.


21

Naber’s Furcation Probe

It is used to determine the extent of furcation involvement on a multi rooted teeth.

It has a curved working end for accessing the furcation area.

The end is blunt so that it will not harm soft tissues.

Most of the nabers probe do not have markings.The depth of insertion of the probe into the

furcation area determines the degree of furcation involvement.


22

Naber’s Furcation Probe


23

Probing Technique

The probe should be inserted parallel to the vertical axis of the tooth and “walked” circumferentially around each tooth to detect the areas of deepest penetration.

To detect an interdental crater the probe should be placed obliquely from both the facial and the lingual surface to explore the deepest point of the pocket located beneath the contact point.

To detect furcation involvement in multi-rooted teeth, use of specially designed Naber’s probe allows an easier and more accurate exploration of the horizontal component of furcation lesion.


24

Probing Technique


25

Probing Technique





26

Probing Technique


27

Probing Technique





28

Probing Technique


29

When to probe

Probing of pockets is done at various times for diagnosis and for monitoring the course of treatment and maintenance.

Initial probing: Done to determine whether the tooth can be saved or should be extracted.

Second probing: Done to establish accurately the level of attachment and degree of involvement of roots and furcations.


30

Pocket Probing

There are two different pocket depths:- The biologic depth is the distance between the gingival margin and the base of the pocket (coronal end of junctional epithelium). This can be measured only by histological sections.- The probing depth is the distance to which the probe penetrates into the pocket.


31

Pocket Probing


32

Pocket Probing

Factors affecting probe penetration:- Force of introduction.- The shape and size of the probe tip.- Degree of tissue inflammation.- Angle of insertion of probe.

The depth of penetration of the probe in the connective tissue apical to the junctional epithelium in a periodontal pocket is about 0.3mm.

The probing forces of 0.75N have been found to be well tolerated and accurate.


33

Thermal Probe

Thermal probes are sensitive diagnostic devices used for measuring early inflammatory changes in the gingival tissues.

One of the commercially available system, the PerioTemp Probe enables the calculation of temperature differential (DT, with a sensitivity of 0.1o

C) between the pocket probed and its sub gingival temperature.

This temperature differential is useful because it allows consideration of differences in core temperature between individuals.


34

Thermal Probe


35

Thermal Probe

Sub gingival temperature at diseased sites is increased compared with healthy sites.

There always exists a natural antero - posterior temperature gradient existing within the dental arches.

Mandibular sites were reported to be warmer than the maxillary sites.

Temperature increases with probing depth due to increase in cellular and molecular activity caused by increased periodontal inflammation with increasing probing depth.


36

Pressure Sensitive Probe

To overcome the limitations of conventional probing system, pressure-sensitive probes are developed which have standardized, controlled insertion pressure.

With forces up to 30 g, the tip of the probe seems to remain within the junctional epithelium, and the forces up to 50 g are necessary to diagnose periodontal osseous defects.


37

Pressure Sensitive Probe


38

National Institute Of Dental and Craniofacial Research (NIDCR)

NIDCR workshop underwent quantitative evaluation of periodontal diseases by physical measurement techniques.

Also, computerization offers the entire dental team the ideal potential to achieve examiner standardization, so that future comparison of health and disease becomes simpler and more precise and remains cost-effective.


39

National Institute Of Dental and Craniofacial Research (NIDCR) criteria for overcoming Conventional Probing

LIMITATION CONVENTIONAL PROBING

NIDCR - CRITERIA

Precision 1 mm 0.1 mmRange 12 mm 10 mm

Probing Force Non standardized Constant and Standardized

Applicability Non invasive and easy to use

Non invasive, lightweight and easy to use

Reach Easy to access any location around all teeth

Easy to access any location around all teeth

Angulation Subjective A guidance system to ensure proper angulation

Security Easily sterilized Complete sterilization of all portions entering the mouth

40

Florida Probing System

The Florida Probing System was developed using the NIDCR criteria.

This automated probe system consists of probe hand piece, digital readout, foot switch, computer interface and computer.

The end of the probe tip is 0.4mm in diameter which reciprocates through a sleeve, and the edge of the sleeve provides a reference by which measurements are made.


41



42



43

Handpiece for assessing probing pocket depths

Handpiece for assessing relative clinical attachment levels



44

Measuring device inserted in sulcus

Probing unit


These measurements are made electronically and transferred automatically to the computer when the foot switch is pressed.

Constant probing force is provided by coil springs inside the probe hand-piece and digital readout.

Advantages:- Precise electronic measurements- Computer storage of data- Constant probing force


45


Disadvantages:- Lack tactile sensitivity.- Underestimation of deep probing depths by the automated probe.


46

Florida Probing System in determination of Clinical Attachment Levels (CAL)

The assessment of clinical attachment levels (CAL) provides information relating to the gain or loss of connective tissue attachment to the root surface, and it is the most practical method of determining that the disease is progressive (active) when a significant loss of attachment has occurred over time.

CAL should be measured ideally from the base of the pocket to the cemento-enamel junction (CEJ), the detection of this anatomic landmark is usually difficult and not easily reproducible by standard probing methods.


47

Florida Probing System in determination of Clinical Attachment Levels (CAL)

The Florida Probe System provides a means of recording relative CAL changes over time.

When using Florida Probe, CALs are recorded relative to a fixed reference point, such as the occlusal surfaces of the teeth (disk probe) or a pre-fabricated stent (stent probe).

These measurements are made sequentially over time and thus differences in relative attachment levels at consecutive examinations must be calculated.


48

Periimplant Probing

The results obtained with periimplant probing cannot be interpreted same as the natural teeth because:- Differences in the surrounding tissues that support implanted teeth.- Probe inserts and penetrates differently.- Around natural teeth, the periodontal probe is resisted by the insertion of supra-crestal connective tissue fibers into the cementum of root surface. There is no equivalent fiber attachment around implants.


49

Periimplant Probing

Advantages:- Can measure the level of mucosal margin relative to a fixed position on the implant. - Measure the depth of tissue around the implant.-Periimplant probing depth is often a measure of the thickness of surrounding connective tissue and correlates most consistently with the with the level of surrounding bone.

The probing depth around implants presumed to be “healthy” has been about 3mm around all surfaces.


50

Conclusion

• The “Gold Standard” for recording changes in periodontal status is longitudinal measurement of clinical attachment levels from the cemento-enamel junction or relative attachment level from a fixed reference point.

• Thus, periodontal probe still remains as a standard and a conventional diagnostic tool inspite of newer diagnostic modalities available currently.


51

References

Carranza’s Clinical Periodontology – 10th edition by Newmann, Takei, Klokkevold and Carranza.

Fundamentals of Periodontal Instrumentation & Advanced Root Preparation – 6th edition by Jill S. Nield-Gehrig.

History of Periodontology.


52

Periodontal Probes 53

THANK YOU

18/03/2010

periodontal probes

Health & Medicine