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KRUPESH RAJANI PERIODONTAL PROBES
Index <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Standard Periodontal Probe </li></ul><ul><li>Classi...
Index <ul><li>NIDCR Criteria </li></ul><ul><li>Florida Probing System </li></ul><ul><li>Florida Probing System for assessm...
Introduction <ul><li>Periodontal probes are used to locate, measure, and mark pockets, as well as determine their course o...
History <ul><li>The third edition of G.V.Black’s  Special Dental Pathology  published in  1924  after his death mentions  ...
History <ul><li>Simoton refers the periodontal probe as a “ Periodontiometer ” and credits W.H.Hamford and C.O.Patten for ...
Standard Periodontal Probe Periodontal Probes <ul><li>The typical probe is a tapered, rod-like instrument calibrated in mi...
Classification <ul><li>Periodontal probes may be divided into: </li></ul><ul><li>First generation probes   are  convention...
Classification <ul><li>Third generation probes   are  computerized probes . Gibbs et al designed  Florida probe. E.g.-Fost...
Types Of Periodontal Probes <ul><li>There are three types of periodontal  </li></ul><ul><li>probes. They are: </li></ul><u...
Explorers 18/03/2010 Periodontal Probes An explorer is an assessment instrument with a flexible wire like working-end. Ass...
Explorers <ul><li>Design of explorers:  </li></ul><ul><li>1. Explorers are made up of flexible metal that conducts vibrati...
Explorers <ul><li>Function of explorers: </li></ul><ul><li>1. Explorers are used to detect, by tactile means, the texture ...
Types Of Calibrated Periodontal Probes <ul><li>Marquis color-coded probe </li></ul><ul><li>UNC-15 probe </li></ul><ul><li>...
Marquis Color-Coded Probe <ul><li>Calibrations are in 3mm sections, markings are 3,6,9,12mm. </li></ul>18/03/2010 Periodon...
The UNC-15 Probe <ul><li>15mm long and markings are at each mm  and coding at the 5 th ,10 th  and 15 th mm. </li></ul><ul...
The University Of Michigan ‘O’ Probe With Williams Markings <ul><li>Markings include 1,2,3,5,7,8 and 9mm with 4mm and 6mm ...
Michigan ‘O’ Probe <ul><li>Markings are at 3, 6, and 8mm. </li></ul>18/03/2010 Periodontal Probes
WHO Probe <ul><li>Prescribed in 1978. </li></ul><ul><li>The probe was designed for two purposes: </li></ul><ul><li>-Measur...
WHO Probe 18/03/2010 Periodontal Probes
WHO Probe <ul><li>Two variants of WHO Probes are available: </li></ul><ul><li>CPITN-E Probe (Epidemiological Probe)  Marki...
Naber’s Furcation Probe <ul><li>It is used to determine the extent of furcation involvement on a multi rooted teeth. </li>...
Naber’s Furcation Probe 18/03/2010 Periodontal Probes
Probing Technique <ul><li>The probe should be inserted parallel to the vertical axis of the tooth and “walked” circumferen...
Probing Technique 18/03/2010 Periodontal Probes
Probing Technique <ul><li>The probe should be inserted parallel to the vertical axis of the tooth and “walked” circumferen...
Probing Technique 18/03/2010 Periodontal Probes
Probing Technique <ul><li>The probe should be inserted parallel to the vertical axis of the tooth and “walked” circumferen...
Probing Technique 18/03/2010 Periodontal Probes
When to probe <ul><li>Probing of pockets is done at various times for diagnosis and for monitoring the course of treatment...
Pocket Probing <ul><li>There are two different pocket depths: </li></ul><ul><li>- The  biologic depth  is the distance bet...
Pocket Probing 18/03/2010 Periodontal Probes
Pocket Probing <ul><li>Factors affecting probe penetration: </li></ul><ul><li>- Force of introduction. </li></ul><ul><li>-...
Thermal Probe <ul><li>Thermal probes are sensitive diagnostic devices used for measuring early inflammatory changes in the...
Thermal Probe 18/03/2010 Periodontal Probes
Thermal Probe <ul><li>Sub gingival temperature at diseased sites is increased compared with healthy sites. </li></ul><ul><...
Pressure Sensitive Probe <ul><li>To overcome the limitations of conventional probing system, pressure-sensitive probes are...
Pressure Sensitive Probe 18/03/2010 Periodontal Probes
National Institute Of Dental and Craniofacial Research (NIDCR) <ul><li>NIDCR workshop underwent quantitative evaluation of...
National Institute Of Dental and Craniofacial Research (NIDCR) criteria for overcoming Conventional Probing LIMITATION CON...
Florida Probing System <ul><li>The Florida Probing System was developed using the NIDCR criteria. </li></ul><ul><li>This a...
Florida Probing System 18/03/2010 Periodontal Probes
Florida Probing System 18/03/2010 Periodontal Probes Handpiece for assessing probing pocket depths Handpiece for assessing...
Florida Probing System 18/03/2010 Periodontal Probes Measuring device inserted in sulcus Probing unit
Florida Probing System <ul><li>These measurements are made electronically and transferred automatically to the computer wh...
Florida Probing System <ul><li>Disadvantages: </li></ul><ul><li>- Lack tactile sensitivity. </li></ul><ul><li>- Underestim...
Florida Probing System in determination of  Clinical Attachment Levels (CAL) <ul><li>The assessment of clinical attachment...
Florida Probing System in determination of  Clinical Attachment Levels (CAL) <ul><li>The Florida Probe System provides a m...
Periimplant Probing <ul><li>The results obtained with periimplant probing cannot be interpreted same as the natural teeth ...
Periimplant Probing <ul><li>Advantages: </li></ul><ul><li>- Can measure the level of mucosal margin relative to a fixed po...
Conclusion <ul><li>The “Gold Standard” for recording changes in periodontal status is longitudinal measurement of clinical...
References <ul><li>Carranza’s Clinical Periodontology – 10 th  edition by Newmann, Takei, Klokkevold and Carranza. </li></...
Periodontal Probes THANK YOU 18/03/2010
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  1. 1. KRUPESH RAJANI PERIODONTAL PROBES
  2. 2. Index <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Standard Periodontal Probe </li></ul><ul><li>Classification </li></ul><ul><li>Types of Periodontal Probe </li></ul><ul><li>Probing technique </li></ul><ul><li>When to probe </li></ul><ul><li>Pocket probing </li></ul><ul><li>Thermal Probe </li></ul><ul><li>Pressure Sensitive Probe </li></ul>18/03/2010 Periodontal Probes
  3. 3. Index <ul><li>NIDCR Criteria </li></ul><ul><li>Florida Probing System </li></ul><ul><li>Florida Probing System for assessment of Clinical Attachment Levels (CAL) </li></ul><ul><li>Periimplant Probing </li></ul><ul><li>Conclusion </li></ul><ul><li>References </li></ul>18/03/2010 Periodontal Probes
  4. 4. Introduction <ul><li>Periodontal probes are used to locate, measure, and mark pockets, as well as determine their course on individual tooth surfaces. </li></ul><ul><li>Periodontal probes are used to measure the depth of pockets and to determine their configuration. </li></ul>Periodontal Probes 18/03/2010
  5. 5. History <ul><li>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 determine the depth of pockets”. These instruments were not calibrated and they were not used for decades. </li></ul><ul><li>Periodontal probe and its use was first described by F.V. Simoton of the University Of California, San Francisco in 1925. </li></ul>18/03/2010 Periodontal Probes
  6. 6. History <ul><li>Simoton refers the periodontal probe as a “ Periodontiometer ” and credits W.H.Hamford and C.O.Patten for its invention. </li></ul><ul><li>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” . </li></ul>18/03/2010 Periodontal Probes
  7. 7. Standard Periodontal Probe Periodontal Probes <ul><li>The typical probe is a tapered, rod-like instrument calibrated in millimeters, with a blunt rounded tip . </li></ul>18/03/2010
  8. 8. Classification <ul><li>Periodontal probes may be divided into: </li></ul><ul><li>First generation probes are conventional , </li></ul><ul><li>and hand held probes , e.g. conventional periodontal probes. </li></ul><ul><li>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. </li></ul>Periodontal Probes 18/03/2010
  9. 9. Classification <ul><li>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. </li></ul><ul><li>Fourth generation probes are the three dimensional probes in which sequential probe positions are measured. </li></ul><ul><li>Fifth generation probes are ultrasonographic probes which provides painless probing to the patient. The guidance path is predetermined in these probes. </li></ul>Periodontal Probes 18/03/2010
  10. 10. Types Of Periodontal Probes <ul><li>There are three types of periodontal </li></ul><ul><li>probes. They are: </li></ul><ul><li>Calibrated periodontal probes </li></ul><ul><li>Naber’s furcation probe </li></ul><ul><li>Computer assisted probes </li></ul>Periodontal Probes 18/03/2010
  11. 11. Explorers 18/03/2010 Periodontal Probes 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.
  12. 12. Explorers <ul><li>Design of explorers: </li></ul><ul><li>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. </li></ul><ul><li>2. Circular in cross-section. </li></ul><ul><li>3. Working end is 1-2mm in length and is referred to as the explorer tip. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  13. 13. Explorers <ul><li>Function of explorers: </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  14. 14. Types Of Calibrated Periodontal Probes <ul><li>Marquis color-coded probe </li></ul><ul><li>UNC-15 probe </li></ul><ul><li>University of Michigan ‘O’ probe, with Williams markings </li></ul><ul><li>Michigan ‘O’ probe </li></ul><ul><li>World Health Organization (WHO) probe </li></ul><ul><li>Naber’s Furcation Probe </li></ul><ul><li>Calibrated probes have blunt, rod shaped working ends that may be circular or rectangular in cross-section. </li></ul>Periodontal Probes 18/03/2010
  15. 15. Marquis Color-Coded Probe <ul><li>Calibrations are in 3mm sections, markings are 3,6,9,12mm. </li></ul>18/03/2010 Periodontal Probes
  16. 16. The UNC-15 Probe <ul><li>15mm long and markings are at each mm and coding at the 5 th ,10 th and 15 th mm. </li></ul><ul><li>Millimeter markings at 1,2,3,4,5,6,7,8,9,10,11,12,13,14 and 15 millimeters . </li></ul>18/03/2010 Periodontal Probes
  17. 17. The University Of Michigan ‘O’ Probe With Williams Markings <ul><li>Markings include 1,2,3,5,7,8 and 9mm with 4mm and 6mm missing. </li></ul>18/03/2010 Periodontal Probes
  18. 18. Michigan ‘O’ Probe <ul><li>Markings are at 3, 6, and 8mm. </li></ul>18/03/2010 Periodontal Probes
  19. 19. WHO Probe <ul><li>Prescribed in 1978. </li></ul><ul><li>The probe was designed for two purposes: </li></ul><ul><li>-Measurement of pocket depth. </li></ul><ul><li>-Detection of sub gingival calculus. </li></ul><ul><li>Used in the assessment of CPITN (Community Periodontal Index for Treatment Needs) </li></ul><ul><li>Weight = 5 gm. </li></ul>18/03/2010 Periodontal Probes
  20. 20. WHO Probe 18/03/2010 Periodontal Probes
  21. 21. WHO Probe <ul><li>Two variants of WHO Probes are available: </li></ul><ul><li>CPITN-E Probe (Epidemiological Probe) Markings at 3.5 and 5.5mm. </li></ul><ul><li>CPITN-C Probe(Clinical Probe) Markings at 3.5, 5.5, 8.5 and 11.5mm. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  22. 22. Naber’s Furcation Probe <ul><li>It is used to determine the extent of furcation involvement on a multi rooted teeth. </li></ul><ul><li>It has a curved working end for accessing the furcation area. </li></ul><ul><li>The end is blunt so that it will not harm soft tissues. </li></ul><ul><li>Most of the nabers probe do not have markings. </li></ul><ul><li>The depth of insertion of the probe into the furcation area determines the degree of furcation involvement. </li></ul>18/03/2010 Periodontal Probes
  23. 23. Naber’s Furcation Probe 18/03/2010 Periodontal Probes
  24. 24. Probing Technique <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  25. 25. Probing Technique 18/03/2010 Periodontal Probes
  26. 26. Probing Technique <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  27. 27. Probing Technique 18/03/2010 Periodontal Probes
  28. 28. Probing Technique <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  29. 29. Probing Technique 18/03/2010 Periodontal Probes
  30. 30. When to probe <ul><li>Probing of pockets is done at various times for diagnosis and for monitoring the course of treatment and maintenance. </li></ul><ul><li>Initial probing: Done to determine whether the tooth can be saved or should be extracted. </li></ul><ul><li>Second probing: Done to establish accurately the level of attachment and degree of involvement of roots and furcations. </li></ul>18/03/2010 Periodontal Probes
  31. 31. Pocket Probing <ul><li>There are two different pocket depths: </li></ul><ul><li>- 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. </li></ul><ul><li>- The probing depth is the distance to which the probe penetrates into the pocket. </li></ul>18/03/2010 Periodontal Probes
  32. 32. Pocket Probing 18/03/2010 Periodontal Probes
  33. 33. Pocket Probing <ul><li>Factors affecting probe penetration: </li></ul><ul><li>- Force of introduction. </li></ul><ul><li>- The shape and size of the probe tip. </li></ul><ul><li>- Degree of tissue inflammation. </li></ul><ul><li>- Angle of insertion of probe. </li></ul><ul><li>The depth of penetration of the probe in the connective tissue apical to the junctional epithelium in a periodontal pocket is about 0.3mm. </li></ul><ul><li>The probing forces of 0.75N have been found to be well tolerated and accurate. </li></ul>18/03/2010 Periodontal Probes
  34. 34. Thermal Probe <ul><li>Thermal probes are sensitive diagnostic devices used for measuring early inflammatory changes in the gingival tissues. </li></ul><ul><li>One of the commercially available system, the PerioTemp Probe enables the calculation of temperature differential (DT, with a sensitivity of 0.1 o C) between the pocket probed and its sub gingival temperature. </li></ul><ul><li>This temperature differential is useful because it allows consideration of differences in core temperature between individuals. </li></ul>18/03/2010 Periodontal Probes
  35. 35. Thermal Probe 18/03/2010 Periodontal Probes
  36. 36. Thermal Probe <ul><li>Sub gingival temperature at diseased sites is increased compared with healthy sites. </li></ul><ul><li>There always exists a natural antero - posterior temperature gradient existing within the dental arches. </li></ul><ul><li>Mandibular sites were reported to be warmer than the maxillary sites. </li></ul><ul><li>Temperature increases with probing depth due to increase in cellular and molecular activity caused by increased periodontal inflammation with increasing probing depth. </li></ul>18/03/2010 Periodontal Probes
  37. 37. Pressure Sensitive Probe <ul><li>To overcome the limitations of conventional probing system, pressure-sensitive probes are developed which have standardized, controlled insertion pressure. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  38. 38. Pressure Sensitive Probe 18/03/2010 Periodontal Probes
  39. 39. National Institute Of Dental and Craniofacial Research (NIDCR) <ul><li>NIDCR workshop underwent quantitative evaluation of periodontal diseases by physical measurement techniques. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  40. 40. National Institute Of Dental and Craniofacial Research (NIDCR) criteria for overcoming Conventional Probing LIMITATION CONVENTIONAL PROBING NIDCR - CRITERIA Precision 1 mm 0.1 mm Range 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
  41. 41. Florida Probing System <ul><li>The Florida Probing System was developed using the NIDCR criteria. </li></ul><ul><li>This automated probe system consists of probe hand piece, digital readout, foot switch, computer interface and computer. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  42. 42. Florida Probing System 18/03/2010 Periodontal Probes
  43. 43. Florida Probing System 18/03/2010 Periodontal Probes Handpiece for assessing probing pocket depths Handpiece for assessing relative clinical attachment levels
  44. 44. Florida Probing System 18/03/2010 Periodontal Probes Measuring device inserted in sulcus Probing unit
  45. 45. Florida Probing System <ul><li>These measurements are made electronically and transferred automatically to the computer when the foot switch is pressed. </li></ul><ul><li>Constant probing force is provided by coil springs inside the probe hand-piece and digital readout. </li></ul><ul><li>Advantages: </li></ul><ul><li>- Precise electronic measurements </li></ul><ul><li>- Computer storage of data </li></ul><ul><li>- Constant probing force </li></ul>18/03/2010 Periodontal Probes
  46. 46. Florida Probing System <ul><li>Disadvantages: </li></ul><ul><li>- Lack tactile sensitivity. </li></ul><ul><li>- Underestimation of deep probing depths by the automated probe. </li></ul>18/03/2010 Periodontal Probes
  47. 47. Florida Probing System in determination of Clinical Attachment Levels (CAL) <ul><li>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. </li></ul><ul><li>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. </li></ul>18/03/2010 Periodontal Probes
  48. 48. Florida Probing System in determination of Clinical Attachment Levels (CAL) <ul><li>The Florida Probe System provides a means of recording relative CAL changes over time. </li></ul><ul><li>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). </li></ul><ul><li>These measurements are made sequentially over time and thus differences in relative attachment levels at consecutive examinations must be calculated. </li></ul>18/03/2010 Periodontal Probes
  49. 49. Periimplant Probing <ul><li>The results obtained with periimplant probing cannot be interpreted same as the natural teeth because: </li></ul><ul><li>- Differences in the surrounding tissues that support implanted teeth. </li></ul><ul><li>- Probe inserts and penetrates differently. </li></ul><ul><li>- 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. </li></ul>18/03/2010 Periodontal Probes
  50. 50. Periimplant Probing <ul><li>Advantages: </li></ul><ul><li>- Can measure the level of mucosal margin relative to a fixed position on the implant. </li></ul><ul><li>- Measure the depth of tissue around the implant. </li></ul><ul><li>-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. </li></ul><ul><li>The probing depth around implants presumed to be “healthy” has been about 3mm around all surfaces. </li></ul>18/03/2010 Periodontal Probes
  51. 51. Conclusion <ul><li>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. </li></ul><ul><li>Thus, periodontal probe still remains as a standard and a conventional diagnostic tool inspite of newer diagnostic modalities available currently. </li></ul>18/03/2010 Periodontal Probes
  52. 52. References <ul><li>Carranza’s Clinical Periodontology – 10 th edition by Newmann, Takei, Klokkevold and Carranza. </li></ul><ul><li>Fundamentals of Periodontal Instrumentation & Advanced Root Preparation – 6 th edition by Jill S. Nield-Gehrig. </li></ul><ul><li>History of Periodontology. </li></ul>18/03/2010 Periodontal Probes
  53. 53. Periodontal Probes THANK YOU 18/03/2010
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