Advanced diagnostic aids in periodontics /certified fixed orthodontic courses by Indian dental academy


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Advanced diagnostic aids in periodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMYLeader in Continuing Dental Education
  2. 2. PERIODONTAL DISEASES Estimated by signs & symptoms of gingival inflammation and periodontal tissue destruction.
  3. 3. CLINICAL
  4. 4. Diagnosed by the clinicalevaluation of signs ofinflammation with orwithout periodontal tissuedestruction.
  5. 5. PERIODONTITIS – MEASUREDBY:A. Loss of connective tissue attachment.B Loss of radiographic bone loss.
  6. 6. Provides info on the pastperiodontal destruction, itsextent and severity
  7. 7. BUT DOES NOT PROVIDE INFOON :Patient’s susceptibilityDisease progression/ remissionPositive/ negative -response to therapy
  8. 8. GINGIVAL INFLAMMATION –Redness of gingivaSwellingGingival bleeding
  9. 9. STUDIES SAY that gingivalbleeding is a sensitive clinicalindicator of early gingivalinflammation !!
  10. 10. It is also a good indicator ofthe presence ofinflammatory lesion in theconnective tissue at the baseof the sulcus.
  11. 11. SEVERITY OF THE BLEEDINGincreases with an increase inthe size of inflammatoryinfiltrate.
  12. 12. RELATION to disease progressionis unclear. healthy sites may also evoke bleeding on probing. Sothe use of gingival bleedingcannot be totally depended upon.
  13. 13. INSTRUMENTS to measuregingival temp has beendeveloped.THERMAL PROBES – measureearly inflammatory changes inthe gingival tissues.EG : PERIOTEMP PROBE
  14. 14. IN PERIODONTITIS, widely useddiagnostic tool is the“periodontal probe” since increasedprobing depth and loss of clinicalattachment are exclusive for thisdisease.
  15. 15.
  16. 16. But use of periodontalprobes presents manyproblems in terms ofsensitivity andreproducibility ofmeasurements.
  17. 17. THE DISPARITY BETWEENMEASUREMENTSDepends on probing techniqueprobing forcesize of the probeangle of insertionprecision of probe calibration.
  18. 18. THE MAIN PROB IN REPRODUCIBILITYvariation in probing force.studies show - forces upto 50g isnecessary for detecting periodontalosseous defects!
  19. 19. NIDCR CRITERIA –FLORIDA PROBE SYSTEM –consists of a probe hand piece, digitalread out, foot switch, computerinterface and computer. tip is 0.4mmin diameter.Data is then transferred to thecomputer .
  21. 21. Electronic probing systems-Interprobe system or Peri probesystem available.Other electronic probes -Fostermiller probe, Toronto automatedprobe, but not released yet.
  23. 23. For detecting destruction ofAlveolar bone, Dental x-rays are mostcommonly used since they providevaluable info on interproximal boneloss.
  24. 24. More than 30% of the bone massat the alveolar crest should belost for a change in bone heightto be seen in dental radiographs.
  25. 25. DIGITAL RADIOGRAPHY – by the use of computerized images, which can be stored, manipulated and corrected for under and over exposures. advantage - diagnostic info can be enhanced.
  26. 26. SUBTRACTION RADIOGRAPHY – used in periodontal diagnosis. Relies on the conversion of serial radiographs into digital images. then they are superimposed to view on a video screen.
  27. 27.
  28. 28. COMPUTER – ASSISTEDDENSITOMETRIC IMAGEANALYSIS SYSTEM – a videocamera measures the lighttransmitted through a radiograph,signals from the cameraconverted into gray scale is fixed to an imageprocessor and a computer
  29. 29. MICROBIAL
  30. 30. MICROBIAL TESTS -can also be used to monitorperiodontal therapy directed atthe suppression or eradication ofperiodontopathic microorganisms
  31. 31. BACTERIAL CULTURING methods are used to detect the specific pathogens present in plaque, by using selective & non selective media.
  32. 32. DISADV Of the above method- strict sampling & transport conditions essential. Putative pathogens like Treponema species & B. forsythes are fastidious & difficult to culture.
  33. 33. Also requires sophisticatedequipments, experiencedpersonnel & time consuming,expensive !!
  34. 34. DARK FIELD OR PHASE CONTRASTMICROSCOPY – alternative method. Directly and rapidly assesses motility and morphology of bacteria in a plaque sample.NON MOTILE ORGANISMS CANNOT BEIDENTIFIED BY THIS METHOD.
  36. 36.
  37. 37. IMMUNOLOGIC ASSAY –employs antibodies whichrecognizes specificbacterial antigens todetect target microorganisms. E.g.:Direct/Indirect IFA, ELISA,Membrane Assay, andLatex Agglutination.
  38. 38. ENZYMATIC METHODS – B. forsythus, P.gingivalis, Treponema denticola and Capnocytophaga- share a common enzymatic profile. Activity of this enzyme can be measured by using diagnostic kits like Perioscan.
  39. 39. OTHER DIAGNOSTIC ADVANCED AIDS ARE Nucleic acid probes, Restriction Endonuclease Analysis and Polymerase Chain Reaction.
  40. 40. ASSESSMENT OF THE HOSTRESPONSE –study of mediators, byimmunologic or biochemicalmethods. Mediators are eitherspecifically identified with theinfection or represent a lessspecific reaction
  41. 41. SAMPLE SOURCES – Saliva, GCF, Gingival Crevicular cells, blood serum, blood cells & urine. Urine samples show little promise except for its use in the differential diagnosis of tooth loss related to Hypophosphatasia in young children.
  42. 42. MORE THAN 40 COMPONENTS OF GCFHAS BEEN STUDIED WHICH CAN BEDIVIDED INTO 3 GROUPS –host derived enzymesinflammatory mediatorstissue breakdown products
  43. 43. SAMPLE COLLECTIONGCF-Method commonly used- Paperstrips.Strips are placed in the sulcus fora standard period of time untilthe paper gets saturated
  44. 44. Fluid volume collected can bequantified by using Periotron.This device measures the changein capacitance across the stripand this change is converted to adigital read out.
  45. 45.
  46. 46. SALIVA – EASE OF COLLECTION….contain bothlocally and systemically derivedmarkers of periodontitis..DIAGNOSTIC MARKERS in salivaproteins & enzymes of host origin,phenotypic markers, host cells,hormones, bacteria & bacterialproducts and ions.
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  48. 48.