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Periodontal indices and dental imaging

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Periodontal Indices and Dental Imaging

Periodontal Indices and Dental Imaging

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  • 1. Milan Chande
  • 2. GINGIVITIS: an inflammatory lesion mediated by host/parasite interaction that remains localised to the gingival tissues and does not extend to involve the pdl, cementum and alveolar bone  PERIODONTITIS: an inflammatory lesion mediated by host/parasite interaction that results in loss of connective tissue attachment to the root surface and ultimately to alveolar bone loss 
  • 3. Gingival Colour  Gingival Texture  BOP (Bleeding on Probing)  Mobility  Presence of Plaque  Presence of Calculus  Pocket Depth  Recession  Presence of Plaque Retention Factors 
  • 4.          This is a screen to see if a patient is periodontally healthy or diseased. Quick and easy to perform If an Initial score of 3 or higher, a DPC is necessary Mouth split into 6 sextants: 7-4 | 3-3 | 4-7 Probing force of 20-25g used All teeth examined but 8s are not generally included unless the 7 is missing Worse score in each sextant is recorded Where no tooth exists in a sextant x/ - is given If only 1 tooth in to sextant, the single tooth is incorporated into the adjacent sextant
  • 5. •Termed E type due to the nature in which it is used. •Used in Epidemiological analysis to see whether patient’s have healthy periodontum or diseased. •Up to 3mm pocket’s indicate a healthy periodontum •Greater than 3mm pocket’s indicate the possibility of periodontal disease. •Greater than 5mm indicates periodontal disease and attachment loss.
  • 6. •Termed C type due to the nature in which it is used. •Used in Clinical analysis to see whether patient’s have healthy periodontum or diseased. •Up to 3mm pocket’s indicate a healthy periodontum •Greater than 3mm pocket’s indicate the possibility of periodontal disease. •Greater than 5mm indicates periodontal disease and attachment loss. •This probe also has a second black band indicating pocket depths of greater than 8mm
  • 7.       Code 0 = No pockets >3.5 mm, no calculus/overhangs, no bleeding after probing (black band completely visible) Code 1 = No pockets >3.5 mm, no calculus/overhangs, but bleeding after probing (black band completely visible) Code 2 = No pockets >3.5 mm, but supra- or subgingival calculus/overhangs (black band completely visible) Code 3 = Probing depth 3.5-5.5 mm (black band partially visible, indicating pocket of 4-5 mm) Code 4 = Probing depth >5.5 mm (black band entirely within the pocket, indicating pocket of 6 mm or more) Code * = Furcation involvement
  • 8.  Code 0 =No need for periodontal treatment  Code 1 = Oral hygiene instruction (OHI)  Code 2 =2 OHI, removal of plaque retentive factors, including all supra- and subgingival calculus  Code 3 =OHI, root surface debridement (RSD)  Code 4 =OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated.  Code * = OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated.
  • 9.  In young people aged 7-19 years the false pockets associated with normal tooth eruption makes it difficult to determine whether a pocket needs periodontal treatment or not.  Therefore in patients more than 12 years old probing is restricted to:  These permanent teeth, being the first to erupt into the mouth, would be the least likely to have false pockets yet the most likely to reveal any true periodontal breakdown.  BPE scores need to be interpreted carefully
  • 10. Used to measure pocket depths.  A pocket measuring probe/ Williams probe is used.   Main components to record: - Pocket depth (mm) - Mobility - Recession (mm) - Bleeding on probing - Furcation
  • 11. Two Blunt Instruments are used to asses a tooth’s mobility. E.g End of mirror and probe  To quantify Mobility, Millers index of mobility is used:      Grade 0 – Normal Physiological mobility (<1mm) Grade 1 – Movement up to 1mm in horizontal plane Grade 2 – Movement greater than 1mm in horizontal plane Grade 3 – Severe mobility greater than 2mm or vertical mobility
  • 12. The furcation is the point at which the two roots divide.  A pocket measuring probe is used.  Ramfjord and Ash furcation index:  Grade 0 – No clinical furcation involved  Grade 1 – Bone loss up to 1/3 width  Grade 2 – Bone loss up to 2/3 width  Grade 3 – Through and through defect
  • 13. •To measure the recession of a individual tooth, a pocket measuring probe must be used. •The probe is placed onto the tooth and the distance between the cemento-enamel junction and the gingival margin is measured. This is the amount of recession that has occurred on that tooth.
  • 14. The pocket measuring probe is inserted into the gingival crevice.  The distance from the base of the pocket and the gingival margin is measured.  In addition, if the site bleeds on probing, circle the score in red and if the site has suppuration (pus) circle the score in blue or black. 
  • 15.  The DPC allows the operator to find sites in the mouth requiring attention.  Sites with pockets greater than 5mm will require RSD.  Subsequent Pocket Depths can be measured after treatment to assess the success of treatment.  You can work out clinical attachment loss (CAL) using the date collected: baseline pocket depth + recession = CAL  CAL represents the true loss of PDL due to periodontal disease
  • 16. http://www.bsperio.org.uk/publications/downloads/39_1  Blackboard Generic Learning Materials > Periodontology  2nd Year Perio Booklet. 
  • 17. Milan Chande
  • 18. There are a number of different types of imaging services available to a Dentist.  Each being beneficial in the diagnosis and overall care of the patient.  A few examples include: • Clinical Photographs • Radiographs • Cone Bean Computed Tomography • Magnetic Resonance Imaging 
  • 19.    Taking such photo’s before, during and after helps both the Dentist and patient look at all the treatment that has been carried out on the patient. The patient will be able to appreciate the amount of work the Dentist has carried out. They will also be able to see the difference all the work has had on the health and appearance of their oral cavity. The Dentist can use these images to evaluate the work he has done. He will be able to understand any obstacles that came across during the procedures undertaken. Thus he will be able to audit himself and ensure he strives to improve on his skills for future patients.
  • 20.          Detection of apical infection/inflammation. Assessment of the periodontal status. After trauma to teeth and associated alveolar bone. Assessment of the presence and position of the unerupted teeth. Assessment of root morphology before extractions. During endodontics. Preoperative assessment and postoperative appraisal of apical surgery Detailed evaluation of apical cysts and other lesions within the alveolar bone. Evaluation of implants postoperatively.
  • 21. Radiographs such as these are taken to find interproximal caries.  They can also be used to assess Interproximal Bone Levels. 
  • 22.          Detection of apical infection/inflammation. Assessment of the periodontal status. After trauma to teeth and associated alveolar bone. Assessment of the presence and position of the unerupted teeth. Assessment of root morphology before extractions. During endodontics. Preoperative assessment and postoperative appraisal of apical surgery Detailed evaluation of apical cysts and other lesions within the alveolar bone. Evaluation of implants postoperatively.
  • 23.      Periapical assessment of the upper anterior teeth, especially children. Detecting the presence of unerupted canines supernumeraries and odontomes. As the midline view, when using the parallax method for determining the bucco/palatal position of unerupted canines. Evaluation of the size and extent of lesions such as cysts or tumours in the anterior maxilla. Assessment of fractures of the anterior teeth and alveolar bone.
  • 24.      The assessment of the presence or position of unerupted teeth. Detection of fractures of the mandible Evaluation of lesions or conditions affecting the jaws, including cysts tumours, giant cell lesions and osteodystrophies. As an alternative when intraoral views are unobtainable because of severe gagging or if the patient is unable to open the mouth or is unconscious. As a specific view of the salivary glands or TMJ
  • 25.      As part of an orthodontic assessment where there is a clinical need to know the state of the dentition and the presence/absence of teeth. To assess bony lesions or an unerupted tooth that are too large to be demonstrated on intraoral films. Prior to dental surgery under GA As part of a periodontal assessment of bone support, where there are pockets greater than 5mm Assessment of third molars, at a time when consideration needs to be given to whether they should be removed
  • 26. Becoming increasingly used in Dentistry in the fields of Orthodontics, Implantology and Endodontics.  It works by producing slices of images of the area concerned using x-rays.  These images are divergent, forming a cone.  Advantages of this technique include it’s ability to record a high level of detail of bone. Therefore able to work around bone levels of the patient. 
  • 27.  Patients are placed into an intense magnetic field.  This forces their hydrogen nuclei to align in the field. Radio Waves are then pulsed into the patient, the hydrogen nuclei ‘wobble’, producing an alteration in the magnetic field.  This induces an electric current in coils placed around the patient.  The computer reads this and is able to produce an image of it.  It is capable of producing any image a CT Scanner can produce, however this becomes difficult as the cost of MRI scan’s is much greater than using traditional methods of radiography.
  • 28. Master Dentistry Volume 1  Blackboard > Dental Radiography Techniques 

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