This document discusses advances in clinical and radiographic diagnostic aids for periodontal disease. It describes limitations of conventional periodontal diagnosis and then covers advances in clinical diagnosis tools like gingival bleeding assessment and gingival temperature measurement. It also discusses advances in periodontal probing techniques, from traditional probes to newer automated probes that provide standardized pressure and direct data collection. The document outlines advances in radiographic assessment including digital radiography and subtraction radiography. It concludes by stating that advanced diagnostic tools can provide more information on disease activity and pathogenesis compared to traditional clinical exams alone.
The document discusses advances in periodontal diagnosis. It covers limitations of conventional diagnosis methods like gingival bleeding, probing, and radiography. It then summarizes various advances in diagnostic tools and techniques, including digital radiography, subtraction radiography, temperature probes, automated probes, microbiological analysis of bacterial species, and analysis of the host immune response. Newer imaging modalities like CBCT are able to provide more detailed 3D evaluation of the alveolar bone for implant planning compared to traditional CT, while delivering a lower radiation dose.
Periodontitis is considered one of the most prevalent immune-inflammatory diseases of the oral cavity. It derives from a specific pathogenic bacteria–host interaction and leads to periodontal tissue destruction [1,2]. The progression of periodontitis is often characterized by irregular phases of increased activity and dormant remission [3,4,5]. Traditional clinical periodontal assessment methods, such as pocket probing depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), and radiological assessment of the alveolar bone volume, are widely used and documented [1,2]. However, these traditional periodontal classification parameters fail to provide noteworthy information on current disease activity, severity and extent of breakdown, future progression and therapy response [2,6]. More importantly, the biological phenotype of the patient is not properly reflected by the clinical assessment methods [7] and the host response to periodontal bacteria and the subsequent inflammatory burden, i.e., the influence of biological phenotype, may largely determine periodontitis progression. Further, an early diagnosis may lead to more successful treatment [8,9].
Periodontitis is considered one of the most prevalent immune-inflammatory diseases of the oral cavity. It derives from a specific pathogenic bacteria–host interaction and leads to periodontal tissue destruction [1,2]. The progression of periodontitis is often characterized by irregular phases of increased activity and dormant remission [3,4,5]. Traditional clinical periodontal assessment methods, such as pocket probing depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), and radiological assessment of the alveolar bone volume, are widely used and documented [1,2]. However, these traditional periodontal classification parameters fail to provide noteworthy information on current disease activity, severity and extent of breakdown, future progression and therapy response [2,6]. More importantly, the biological phenotype of the patient is not properly reflected by the clinical assessment methods [7] and the host response to periodontal bacteria and the subsequent inflammatory burden, i.e., the influence of biological phenotype, may largely determine periodontitis progression. Further, an early diagnosis may lead to more successful treatment [8,9].
Radiographs and clinical examinations are important for assessing periodontal disease. Radiographs identify bone loss and other factors. Clinical exams measure probing depth, recession, mobility and inflammation. Microbiological tests identify pathogens while immunological tests detect bacterial antigens. Investigations of oral lesions associated with HIV include ELISA, Western Blot and PCR tests. Radiographs and percussion help evaluate endodontic-periodontal lesions. Tests for halitosis include organoleptic assessment and measuring volatile sulfur compounds.
Dr. Nael Al Masri provides a comprehensive overview of periodontal examination and diagnosis. The summary includes:
1. A periodontal examination involves assessing the patient's medical and dental history, examining plaque, gingiva, probing depths, clinical attachment levels, bleeding, bone loss, tooth mobility, and furcation involvement.
2. Key findings that help determine a diagnosis include probing depths above 3mm, clinical attachment loss, bleeding on probing, recession, furcation involvement, and tooth mobility.
3. The examination is used to establish a diagnosis, prognosis, and develop a customized treatment plan for the patient.
This document discusses the components of a periodontal examination, including:
1. Gathering medical and dental history from the patient to identify risk factors.
2. Examining the mouth for signs of inflammation like bleeding, calculus, and halitosis.
3. Measuring probing depth, clinical attachment level, recession, bone loss, mobility and furcation involvement to determine periodontal disease severity and prognosis.
4. Developing a treatment plan based on the examination findings.
Advanced diagnostic aids provide clinicians with improved tools for periodontal diagnosis. Recent advances include more precise periodontal probes that control probing force, non-invasive diagnostic methods like gingival temperature measurement, and improved microbial analysis techniques. Molecular biology techniques allow for detection of specific periodontal pathogens through DNA/RNA analysis and probes. These diagnostic advances enhance detection of disease presence, type, and activity level to improve treatment planning and outcomes.
The document discusses advances in periodontal diagnosis. It covers limitations of conventional diagnosis methods like gingival bleeding, probing, and radiography. It then summarizes various advances in diagnostic tools and techniques, including digital radiography, subtraction radiography, temperature probes, automated probes, microbiological analysis of bacterial species, and analysis of the host immune response. Newer imaging modalities like CBCT are able to provide more detailed 3D evaluation of the alveolar bone for implant planning compared to traditional CT, while delivering a lower radiation dose.
Periodontitis is considered one of the most prevalent immune-inflammatory diseases of the oral cavity. It derives from a specific pathogenic bacteria–host interaction and leads to periodontal tissue destruction [1,2]. The progression of periodontitis is often characterized by irregular phases of increased activity and dormant remission [3,4,5]. Traditional clinical periodontal assessment methods, such as pocket probing depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), and radiological assessment of the alveolar bone volume, are widely used and documented [1,2]. However, these traditional periodontal classification parameters fail to provide noteworthy information on current disease activity, severity and extent of breakdown, future progression and therapy response [2,6]. More importantly, the biological phenotype of the patient is not properly reflected by the clinical assessment methods [7] and the host response to periodontal bacteria and the subsequent inflammatory burden, i.e., the influence of biological phenotype, may largely determine periodontitis progression. Further, an early diagnosis may lead to more successful treatment [8,9].
Periodontitis is considered one of the most prevalent immune-inflammatory diseases of the oral cavity. It derives from a specific pathogenic bacteria–host interaction and leads to periodontal tissue destruction [1,2]. The progression of periodontitis is often characterized by irregular phases of increased activity and dormant remission [3,4,5]. Traditional clinical periodontal assessment methods, such as pocket probing depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), and radiological assessment of the alveolar bone volume, are widely used and documented [1,2]. However, these traditional periodontal classification parameters fail to provide noteworthy information on current disease activity, severity and extent of breakdown, future progression and therapy response [2,6]. More importantly, the biological phenotype of the patient is not properly reflected by the clinical assessment methods [7] and the host response to periodontal bacteria and the subsequent inflammatory burden, i.e., the influence of biological phenotype, may largely determine periodontitis progression. Further, an early diagnosis may lead to more successful treatment [8,9].
Radiographs and clinical examinations are important for assessing periodontal disease. Radiographs identify bone loss and other factors. Clinical exams measure probing depth, recession, mobility and inflammation. Microbiological tests identify pathogens while immunological tests detect bacterial antigens. Investigations of oral lesions associated with HIV include ELISA, Western Blot and PCR tests. Radiographs and percussion help evaluate endodontic-periodontal lesions. Tests for halitosis include organoleptic assessment and measuring volatile sulfur compounds.
Dr. Nael Al Masri provides a comprehensive overview of periodontal examination and diagnosis. The summary includes:
1. A periodontal examination involves assessing the patient's medical and dental history, examining plaque, gingiva, probing depths, clinical attachment levels, bleeding, bone loss, tooth mobility, and furcation involvement.
2. Key findings that help determine a diagnosis include probing depths above 3mm, clinical attachment loss, bleeding on probing, recession, furcation involvement, and tooth mobility.
3. The examination is used to establish a diagnosis, prognosis, and develop a customized treatment plan for the patient.
This document discusses the components of a periodontal examination, including:
1. Gathering medical and dental history from the patient to identify risk factors.
2. Examining the mouth for signs of inflammation like bleeding, calculus, and halitosis.
3. Measuring probing depth, clinical attachment level, recession, bone loss, mobility and furcation involvement to determine periodontal disease severity and prognosis.
4. Developing a treatment plan based on the examination findings.
Advanced diagnostic aids provide clinicians with improved tools for periodontal diagnosis. Recent advances include more precise periodontal probes that control probing force, non-invasive diagnostic methods like gingival temperature measurement, and improved microbial analysis techniques. Molecular biology techniques allow for detection of specific periodontal pathogens through DNA/RNA analysis and probes. These diagnostic advances enhance detection of disease presence, type, and activity level to improve treatment planning and outcomes.
Periodontal diagnostic tests include clinical methods, radiographic methods, microbial analysis, and host response analysis. Clinical methods include gingival bleeding, periodontal probing, tooth mobility, gingival temperature, and halitosis. Bleeding on probing and increased gingival temperature can indicate inflammation but are not reliable predictors of future attachment loss. Periodontal probing is important but multiple factors can affect accuracy. Digital radiography and subtraction radiography allow for enhanced detection and quantification of alveolar bone loss compared to conventional radiographs.
This document discusses advances in diagnostic aids for periodontal diseases. It begins by defining diagnostic aids and explaining their importance. It then discusses various categories of diagnostic aids including clinical aids like probing, radiographic aids like digital radiography and subtraction radiography, and microbial diagnostic aids like bacterial culturing, DNA probes, and immunoassays. Newer diagnostic techniques discussed include the perioscope, optical coherence tomography, near-infrared spectroscopy, ultrasound, and confocal laser scanning microscopy. The document emphasizes that while many new techniques show promise, no single tool currently meets all the ideal criteria of an effective diagnostic aid.
This document discusses advances in clinical diagnosis of periodontal diseases. It covers various diagnostic methods including gingival bleeding, gingival temperature measurement using thermal probes, periodontal probing techniques that have evolved from manual to digital probes, advances in radiographic assessment including digital and subtraction radiography, and microbiological diagnostic methods like bacterial culturing and molecular biology techniques. It also addresses advances in characterizing the host immune response through analysis of inflammatory markers and gene expression profiles.
This document discusses various diagnostic aids used for periodontal disease, including gingival bleeding, subgingival temperature, periodontal probing, and radiography. It describes how gingival bleeding and increased subgingival temperature can indicate inflammation but have limitations as diagnostic tools. Various periodontal probes are presented, including manual probes, automated probes like the Florida Probe System, and newer probes aiming to standardize measurements. Digital radiography and techniques like subtraction radiography are highlighted as providing advantages over conventional radiography for enhanced diagnosis of periodontal bone loss.
This document discusses advances in diagnostic tools for periodontal disease. It covers several generations of periodontal probes from conventional to computer-linked electronic probes. The third generation combines controlled probing force, automated measurement, and computerized data capture. This improves measurement resolution and eliminates issues with rounding measurements. The document also discusses other diagnostic tools like thermal probes, periotrons, and volatile sulfur compound meters and their advantages and limitations.
This case report describes a 62-year-old female patient who presented with a non-healing gingival lesion. Initial biopsy found non-specific inflammation and giant cells suggestive of pyogenic granuloma. Two years later when the lesion had increased in size, investigations revealed miliary nodules in the lungs and a granulomatous infection. Tuberculin test was weakly positive and culture from biopsy grew Mycobacterium tuberculosis. The patient was diagnosed with secondary oral tuberculosis from post-primary pulmonary tuberculosis and showed improvement with antitubercular treatment. The report discusses the rare occurrence of oral tuberculosis lesions and challenges in diagnosis.
The document discusses various advanced diagnostic aids used in periodontal diagnosis. It summarizes conventional diagnostic methods and their limitations. It then describes advances in clinical diagnosis using probes, radiographic assessment using digital radiography and subtraction radiography. It also discusses advances in microbiological analysis using methods like bacterial culturing, direct microscopy, immunodiagnostic assays and molecular techniques like PCR. Advances in characterizing the host response using markers of inflammation are also highlighted.
Advanced periodontal diagnostic techniques provide more precise information about periodontal disease beyond conventional methods like probing. New tools include digital radiography, subtraction radiography, cone-beam CT, and microbiological assays. Periodontal probes also improved from early generations that lacked standardization to current automated probes that control probing force and directly capture data. These advanced techniques enhance detection of bone loss, monitor disease activity, and identify pathogens involved.
Advanced Diagnostic Aids in Periodontology .pptxDanish Hamid
In periodontology, advanced diagnostic aids include techniques like digital radiography, cone beam computed tomography (CBCT), microbiological and biochemical studies and advanced periodontal probing. These tools help in assessing bone levels, identifying periodontal pockets, and planning effective treatment strategies. Additionally, biomarker analysis and genetic testing are emerging areas for understanding individual susceptibility to periodontal diseases.
advanced diagnostic aids in periodontics.pptxViola Esther
Advanced periodontal diagnostic techniques provide more information than conventional methods. New clinical tools more accurately measure inflammation, while radiographic advances like digital radiography and cone-beam CT provide 3D imaging. Microbiological tests identify specific pathogens through methods like polymerase chain reaction. Assessing inflammatory mediators and enzymes in gingival crevicular fluid can also characterize the host response beyond traditional measures of attachment loss and bone destruction. However, no single diagnostic has proven able to predict disease progression, so conventional evaluation remains the standard for assessing periodontal status.
Periodontitis is a chronic, slowly progressing disease which mainly results in the destruction of tooth supporting apparatus. Earlier it was classified as Chronic and Aggressive periodontitis with different clinical features and etiology. Current classification ( 2017) of periodontal disease involves periodontitis with is further divided into 4 stages and 3 grades depending on severity and rate of disease progression respectively. Diabetes meelitus and smoking are the validated risk factors for the progression of periodontitis.
The American Academy of Periodontology Task Force updated the 1999 Classification of Periodontal Diseases and Conditions to address concerns from educators, examiners, and clinicians. The update focused on 3 areas: using attachment level in diagnosis, differentiating chronic and aggressive periodontitis, and defining localized and generalized periodontitis. For chronic periodontitis, the Task Force recommended using probing depth and clinical attachment loss to determine severity. They affirmed chronic and aggressive periodontitis as distinct based on age of onset, rate of progression, and levels of biofilm and calculus. For aggressive periodontitis, age under 25 at onset helps diagnosis. Localized chronic periodontitis is defined as ≤30% of teeth affected or a clear pattern, while
This document discusses advances in periodontal diagnostic techniques beyond conventional methods. It covers advances in clinical diagnosis including gingival temperature measurement and automated periodontal probes. For radiographic assessment, it discusses digital radiography, subtraction radiography, CADIA, CT, and CBCT. Under microbiological analysis, it outlines advances like immunohistodiagnostic methods using immunofluorescence, flow cytometry and ELISA. It also discusses enzymatic methods like BANA testing and molecular biology techniques including nucleic acid probes and DNA hybridization.
The document discusses the changing paradigm in dental care from the nonspecific plaque hypothesis (NSPH) to the specific plaque hypothesis (SPH). It summarizes the key differences between the two approaches. The NSPH assumed all plaque was equally pathogenic, while more recent evidence shows only certain plaque bacteria cause infections. The SPH recognizes healthy and infected plaque can be differentiated microbiologically, enabling more targeted treatment of the infection-causing bacteria.
This document discusses principles and techniques of biopsy. It outlines the steps in evaluating a patient with an oral lesion, including health history, lesion history, clinical and radiographic exams, and laboratory tests. It describes different types of biopsies and provides guidance on surgical principles like anesthesia, hemostasis, and handling specimens. Intraosseous biopsies require special considerations for access and removal. Overall it provides a comprehensive overview of best practices for oral biopsies.
The document provides information on performing a thorough periodontal examination, including objectives, components, and techniques. It describes examining the gingiva, probing depth, clinical attachment level, bleeding on probing, tooth mobility, furcations, mucogingival tissues, occlusion, and radiographs. The goals are to identify pathological changes, document clinical findings, analyze the data, and develop an overall diagnosis for the patient. Accurately collecting and interpreting this examination data is important for understanding the periodontal condition.
This document discusses principles and techniques of biopsy. It outlines the steps involved in evaluating a patient with an oral lesion including taking a health history, examining the lesion history, performing a clinical and radiographic exam, and potentially obtaining laboratory tests. It describes different types of biopsies including incisional, excisional, and intraosseous biopsies. Principles of biopsy such as anesthesia, hemostasis, handling specimens, and closure techniques are also outlined. The goal is to obtain sufficient tissue for accurate histopathologic evaluation.
This document outlines the principles and techniques of biopsy for oral and maxillofacial lesions. It discusses the importance of a systematic approach including health history, lesion history, clinical and radiographic exams, and laboratory tests. Different types of biopsies are described such as incisional, excisional, needle and their indications. Principles of biopsy surgery include anesthesia, hemostasis, specimen handling and closure. Characteristics suggesting malignancy and indications for biopsy are provided. Biopsy of hard and intraosseous tissues also discussed.
This document outlines the principles and techniques of biopsy for oral and maxillofacial lesions. It discusses the importance of a systematic approach including health history, lesion history, clinical and radiographic exams, and laboratory tests. Different types of biopsies are described such as incisional, excisional, needle, and intraosseous. Key principles of biopsy surgery are emphasized like anesthesia, hemostasis, specimen handling, and closure. The goal is to obtain an adequate tissue sample for accurate histopathologic evaluation while following principles of safe excisional surgery.
The document discusses principles of oral biopsy for dentists. It describes how dentists can play a key role in early detection of oral cancer through thorough exams and biopsies of suspicious lesions. It covers indications for biopsy, different biopsy types like incisional and excisional, proper biopsy technique, handling of specimens, and potential errors. The goal of biopsy is to diagnose lesions histopathologically and help determine prognosis and appropriate treatment.
Periodontal disease has a two-way relationship with systemic health conditions. It can influence systemic health while certain systemic conditions can also increase susceptibility to periodontal disease. Periodontal disease is associated with increased risk of cardiovascular disease, cerebrovascular accidents, diabetes and other conditions. Potential mechanisms include direct effects of periodontal pathogens, host inflammatory responses, common risk factors and genetic predispositions. Periodontitis may enhance atherosclerosis through direct bacterial effects, increased inflammatory markers, platelet aggregation and other indirect host responses.
This document discusses periodontal pockets, including their classification, clinical features, pathogenesis, and histopathology. Periodontal pockets are pathologically deepened gingival sulci that are a key feature of periodontal disease. They can form via gingival enlargement or destruction of supporting tissues. Histologically, the soft tissue wall shows edema, inflammation and sometimes fibrosis or ulceration. Bacteria may accumulate in the pocket and invade tissues. The pocket represents an area of ongoing healing and destruction in response to the bacterial challenge.
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Periodontal diagnostic tests include clinical methods, radiographic methods, microbial analysis, and host response analysis. Clinical methods include gingival bleeding, periodontal probing, tooth mobility, gingival temperature, and halitosis. Bleeding on probing and increased gingival temperature can indicate inflammation but are not reliable predictors of future attachment loss. Periodontal probing is important but multiple factors can affect accuracy. Digital radiography and subtraction radiography allow for enhanced detection and quantification of alveolar bone loss compared to conventional radiographs.
This document discusses advances in diagnostic aids for periodontal diseases. It begins by defining diagnostic aids and explaining their importance. It then discusses various categories of diagnostic aids including clinical aids like probing, radiographic aids like digital radiography and subtraction radiography, and microbial diagnostic aids like bacterial culturing, DNA probes, and immunoassays. Newer diagnostic techniques discussed include the perioscope, optical coherence tomography, near-infrared spectroscopy, ultrasound, and confocal laser scanning microscopy. The document emphasizes that while many new techniques show promise, no single tool currently meets all the ideal criteria of an effective diagnostic aid.
This document discusses advances in clinical diagnosis of periodontal diseases. It covers various diagnostic methods including gingival bleeding, gingival temperature measurement using thermal probes, periodontal probing techniques that have evolved from manual to digital probes, advances in radiographic assessment including digital and subtraction radiography, and microbiological diagnostic methods like bacterial culturing and molecular biology techniques. It also addresses advances in characterizing the host immune response through analysis of inflammatory markers and gene expression profiles.
This document discusses various diagnostic aids used for periodontal disease, including gingival bleeding, subgingival temperature, periodontal probing, and radiography. It describes how gingival bleeding and increased subgingival temperature can indicate inflammation but have limitations as diagnostic tools. Various periodontal probes are presented, including manual probes, automated probes like the Florida Probe System, and newer probes aiming to standardize measurements. Digital radiography and techniques like subtraction radiography are highlighted as providing advantages over conventional radiography for enhanced diagnosis of periodontal bone loss.
This document discusses advances in diagnostic tools for periodontal disease. It covers several generations of periodontal probes from conventional to computer-linked electronic probes. The third generation combines controlled probing force, automated measurement, and computerized data capture. This improves measurement resolution and eliminates issues with rounding measurements. The document also discusses other diagnostic tools like thermal probes, periotrons, and volatile sulfur compound meters and their advantages and limitations.
This case report describes a 62-year-old female patient who presented with a non-healing gingival lesion. Initial biopsy found non-specific inflammation and giant cells suggestive of pyogenic granuloma. Two years later when the lesion had increased in size, investigations revealed miliary nodules in the lungs and a granulomatous infection. Tuberculin test was weakly positive and culture from biopsy grew Mycobacterium tuberculosis. The patient was diagnosed with secondary oral tuberculosis from post-primary pulmonary tuberculosis and showed improvement with antitubercular treatment. The report discusses the rare occurrence of oral tuberculosis lesions and challenges in diagnosis.
The document discusses various advanced diagnostic aids used in periodontal diagnosis. It summarizes conventional diagnostic methods and their limitations. It then describes advances in clinical diagnosis using probes, radiographic assessment using digital radiography and subtraction radiography. It also discusses advances in microbiological analysis using methods like bacterial culturing, direct microscopy, immunodiagnostic assays and molecular techniques like PCR. Advances in characterizing the host response using markers of inflammation are also highlighted.
Advanced periodontal diagnostic techniques provide more precise information about periodontal disease beyond conventional methods like probing. New tools include digital radiography, subtraction radiography, cone-beam CT, and microbiological assays. Periodontal probes also improved from early generations that lacked standardization to current automated probes that control probing force and directly capture data. These advanced techniques enhance detection of bone loss, monitor disease activity, and identify pathogens involved.
Advanced Diagnostic Aids in Periodontology .pptxDanish Hamid
In periodontology, advanced diagnostic aids include techniques like digital radiography, cone beam computed tomography (CBCT), microbiological and biochemical studies and advanced periodontal probing. These tools help in assessing bone levels, identifying periodontal pockets, and planning effective treatment strategies. Additionally, biomarker analysis and genetic testing are emerging areas for understanding individual susceptibility to periodontal diseases.
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Advanced periodontal diagnostic techniques provide more information than conventional methods. New clinical tools more accurately measure inflammation, while radiographic advances like digital radiography and cone-beam CT provide 3D imaging. Microbiological tests identify specific pathogens through methods like polymerase chain reaction. Assessing inflammatory mediators and enzymes in gingival crevicular fluid can also characterize the host response beyond traditional measures of attachment loss and bone destruction. However, no single diagnostic has proven able to predict disease progression, so conventional evaluation remains the standard for assessing periodontal status.
Periodontitis is a chronic, slowly progressing disease which mainly results in the destruction of tooth supporting apparatus. Earlier it was classified as Chronic and Aggressive periodontitis with different clinical features and etiology. Current classification ( 2017) of periodontal disease involves periodontitis with is further divided into 4 stages and 3 grades depending on severity and rate of disease progression respectively. Diabetes meelitus and smoking are the validated risk factors for the progression of periodontitis.
The American Academy of Periodontology Task Force updated the 1999 Classification of Periodontal Diseases and Conditions to address concerns from educators, examiners, and clinicians. The update focused on 3 areas: using attachment level in diagnosis, differentiating chronic and aggressive periodontitis, and defining localized and generalized periodontitis. For chronic periodontitis, the Task Force recommended using probing depth and clinical attachment loss to determine severity. They affirmed chronic and aggressive periodontitis as distinct based on age of onset, rate of progression, and levels of biofilm and calculus. For aggressive periodontitis, age under 25 at onset helps diagnosis. Localized chronic periodontitis is defined as ≤30% of teeth affected or a clear pattern, while
This document discusses advances in periodontal diagnostic techniques beyond conventional methods. It covers advances in clinical diagnosis including gingival temperature measurement and automated periodontal probes. For radiographic assessment, it discusses digital radiography, subtraction radiography, CADIA, CT, and CBCT. Under microbiological analysis, it outlines advances like immunohistodiagnostic methods using immunofluorescence, flow cytometry and ELISA. It also discusses enzymatic methods like BANA testing and molecular biology techniques including nucleic acid probes and DNA hybridization.
The document discusses the changing paradigm in dental care from the nonspecific plaque hypothesis (NSPH) to the specific plaque hypothesis (SPH). It summarizes the key differences between the two approaches. The NSPH assumed all plaque was equally pathogenic, while more recent evidence shows only certain plaque bacteria cause infections. The SPH recognizes healthy and infected plaque can be differentiated microbiologically, enabling more targeted treatment of the infection-causing bacteria.
This document discusses principles and techniques of biopsy. It outlines the steps in evaluating a patient with an oral lesion, including health history, lesion history, clinical and radiographic exams, and laboratory tests. It describes different types of biopsies and provides guidance on surgical principles like anesthesia, hemostasis, and handling specimens. Intraosseous biopsies require special considerations for access and removal. Overall it provides a comprehensive overview of best practices for oral biopsies.
The document provides information on performing a thorough periodontal examination, including objectives, components, and techniques. It describes examining the gingiva, probing depth, clinical attachment level, bleeding on probing, tooth mobility, furcations, mucogingival tissues, occlusion, and radiographs. The goals are to identify pathological changes, document clinical findings, analyze the data, and develop an overall diagnosis for the patient. Accurately collecting and interpreting this examination data is important for understanding the periodontal condition.
This document discusses principles and techniques of biopsy. It outlines the steps involved in evaluating a patient with an oral lesion including taking a health history, examining the lesion history, performing a clinical and radiographic exam, and potentially obtaining laboratory tests. It describes different types of biopsies including incisional, excisional, and intraosseous biopsies. Principles of biopsy such as anesthesia, hemostasis, handling specimens, and closure techniques are also outlined. The goal is to obtain sufficient tissue for accurate histopathologic evaluation.
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This document outlines the principles and techniques of biopsy for oral and maxillofacial lesions. It discusses the importance of a systematic approach including health history, lesion history, clinical and radiographic exams, and laboratory tests. Different types of biopsies are described such as incisional, excisional, needle, and intraosseous. Key principles of biopsy surgery are emphasized like anesthesia, hemostasis, specimen handling, and closure. The goal is to obtain an adequate tissue sample for accurate histopathologic evaluation while following principles of safe excisional surgery.
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This document discusses periodontal pockets, including their classification, clinical features, pathogenesis, and histopathology. Periodontal pockets are pathologically deepened gingival sulci that are a key feature of periodontal disease. They can form via gingival enlargement or destruction of supporting tissues. Histologically, the soft tissue wall shows edema, inflammation and sometimes fibrosis or ulceration. Bacteria may accumulate in the pocket and invade tissues. The pocket represents an area of ongoing healing and destruction in response to the bacterial challenge.
This document provides an overview of periodontal pockets, including:
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- Clinical features such as signs of inflammation, bleeding, mobility, and symptoms like pain, sensitivity, and loose teeth.
- Pathogenesis involving the inflammatory response to bacteria, cytokine production, collagen degradation, and pocket formation through destruction of tissues.
- Histopathology showing features like edema, infiltration of leukocytes, epithelial proliferation and degeneration, and bacterial invasion along the pocket walls.
This document discusses different types of gingival enlargement, including classifications, indices used to measure enlargement, etiologies such as inflammation, drugs, systemic diseases, and tumors. It describes clinical features and histopathology of various types of enlargement. Drug-induced enlargement is discussed in detail, covering factors like age and genetics that influence susceptibility. The multifactorial nature and pathophysiology of drug-induced gingival overgrowth is also summarized.
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Calculus, also known as dental calculus or tartar, is mineralized bacterial plaque that forms on teeth. It consists of both inorganic and organic components. The inorganic portion is primarily calcium phosphate in the form of hydroxyapatite, magnesium whitlockite, octacalcium phosphate, and brushite. Calculus forms more readily in areas of plaque stagnation. Several theories exist as to its mineralization process, involving increases in pH, salivary proteins, and bacterial enzymes. Calculus promotes further plaque formation and contributes to periodontal disease. Its removal is an important part of periodontal therapy and oral hygiene maintenance.
1) Lasers have various applications in periodontal and implant dentistry including calculus removal, soft tissue excision and ablation, root decontamination, biostimulation, and bacteria reduction.
2) Studies show lasers may provide benefits like less swelling and pain compared to conventional methods.
3) Different laser wavelengths penetrate tissues to varying depths depending on characteristics, and care must be taken to avoid overheating implants which could damage surfaces.
1) The document discusses the use of nanotechnology in periodontal management and dentistry.
2) Key applications discussed include nanodiagnostics, nanoparticles for targeted drug delivery, and nanomaterials for dental treatments and prevention.
3) Examples provided are quantum dots and gold nanoparticles for imaging and detecting oral cancer, and nanofillers/silver nanoparticles for dental composites and coatings to prevent plaque formation.
Fibrin sealant mimics the final stage of the coagulation cascade by activating fibrinogen to form a fibrin clot. It has hemostatic and adhesive properties useful for periodontal surgery. Fibrin sealant can be used to secure grafts and flaps better than sutures alone. It may also aid periodontal regeneration by stabilizing the clot and protecting the regenerative space. Fibrin sealant can deliver growth factors and stem cells locally to further enhance healing. Overall, fibrin sealant is a biocompatible tissue adhesive with applications in periodontal and dental surgery.
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Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Physiology and chemistry of skin and pigmentation, hairs, scalp, lips and nail, Cleansing cream, Lotions, Face powders, Face packs, Lipsticks, Bath products, soaps and baby product,
Preparation and standardization of the following : Tonic, Bleaches, Dentifrices and Mouth washes & Tooth Pastes, Cosmetics for Nails.
3. CONTENTS
INTRODUCTION
LIMITATIONS OF CONVENTIONAL PERIODONTAL DIAGNOSIS
ADVANCES IN CLINICAL DIAGNOSIS
Gingival Bleeding
Gingival Temperature
Periodontal Probing
ADVANCES IN RADIOGRAPHIC ASSESSMENT
Digital Radiography
Subtraction Radiography
Computer-Assisted Densitometric Image Analysis System (CADIA)
CONCLUSION
REFERENCES
4. INTRODUCTION
Periodontal diseases are conventionally diagnosed by clinical
evaluation of the signs of inflammation in gingiva with or without
the presence of periodontal destruction.
The traditional clinical diagnosis of periodontitis is made by
measuring either clinical attachment loss or radiographic bone loss.
5. Limitations of Periodontal Diagnosis:
Cannot identify sites with on going periodontal destruction
Does not provide any information regarding the cause of the condition
Patient susceptibility to disease
Whether the disease is active or in remission state
Response to therapy either positive or negative
6. Periodontal disease process itself considered to be site specific and multifactorial origin in
which
periodontal pathogens
host response
genetic factors
systemic
behavioral factors interplay.
Consideration should be given to including microbiologic, immunologic, systemic, genetic
and behavioral factors in addition to traditional clinical and radiographical parameters
7. ADVANCED DIAGNOSTIC AIDS
Advances in Clinical diagnosis
Advances in Radiographic Assessment
Advances in Microbiologic Analysis
Advances in Characterizing the Host Response
Advances In Genetic Assessment
Advanced Diagnostic Aids In Detecting Halitosis
Advanced Diagnostic Tool To Study Occlusal Stresses
9. GINGIVAL BLEEDING
Clinical evaluation of the degree of
gingival inflammation include
Redness
Swelling
Gingival bleeding
Earliest clinical signs of gingivitis
consist of color and texture changes,
there may be underlying structural
alterations without corresponding
clinical signs
10. Gingival bleeding is a sensitive clinical
indicator of early gingival inflammation.
Gingival bleeding as an indicator of
inflammation has the clinical advantage of
being more objective, since color changes
require a subjective estimation.
It has also been shown of an inflammatory
lesion in the connective tissue at the base
of the sulcus and that the severity of
bleeding increases with an increase in size
of the inflammatory infiltrate
11. Lang et al in a retrospective study -
sites that bleed on probing at several
visits had a higher probability of losing
attachment than those that bleed at one
visit or did not bleed.
Longitudinal studies - failed to
demonstrate a significant correlation
between bleeding on probing and other
clinical signs and subsequent loss of
attachment.
12. A further limitation of use of bleeding as an inflammatory parameter is the possibility
that healthy sites may bleed on probing.
Lang et al demonstrated that any force greater than 0.25 N may evoke bleeding in
healthy sites with an intact periodontium.
Depending on the severity of inflammation, bleeding can vary from a tenuous red line
along the gingival sulcus to profuse bleeding.
If periodontal treatment is successful, bleeding on probing will cease.
13. To test for bleeding after probing, the probe is carefully introduced to the
bottom of the pocket and gently moved laterally along the pocket wall.
As a single test, bleeding on probing is not a good predictor of
progressive attachment loss; absence - excellent predictor of periodontal
stability.
When bleeding is present in multiple sites of advanced disease, bleeding
on probing is a good indicator of progressive attachment loss.
14. GINGIVAL TEMPERATURE
Thermal probes are sensitive diagnostic
devices for measuring early
inflammatory changes in gingival tissue.
(Kung et al 1990)
Commercially available system
periotemp probe
Individual temperature differences are
compared with those expected for each
tooth and higher temperature pockets
are signaled with a red emitting diode.
15. Probe has two light indicating diodes:
Red-emitting diode - which indicates
higher temperature, denoting risk is twice
as likely for future attachment loss
Green-emitting diode - which indicates a
lower temperature, indicating lower risk
Influence of pocket depth on temperature is
still not clear
Presence of surface cooling caused by breath
airflow may further complicate the
determination of even a normal temperature
distribution
16. Perio Temp® probe - detects pocket temperature differences of 0.1° C from a
referenced subgingival temperature
A naturally occurring temperature gradient exists between maxillary and
mandibular teeth and between posterior and anterior teeth
Subgingival temperature at diseased sites is increased as compared to normal
healthy sites
17. PERIODONTAL PROBING
The word probe is derived from the Latin word Probo, which means "to test."
Most widely used for clinical assessment of connective tissue destruction in periodontitis
Gold standard – recording changes in periodontal status
Probing depth is measured from the free gingival margin (FGM) to the depth of the pocket
Not the most objective measure of loss of periodontal tissues
Increased probing depth and loss of clinical attachment are pathognomonic for periodontitis
18. CAL is a more objective measure of loss of existing periodontal support.
CAL also does not give any indication of current disease activity.
When interpreting the PD and CAL measurements made with conventional periodontal
probes, it is important to consider that these values depend on the inflammatory state of
the tissues.
Force to probe pocket: 30g
Force to probe periodontal osseous defect: 50g
19. Periodontal probe presents many problems in terms of
Sensitivity
Reproducibility of the measurements.
Readings of clinical pocket depth obtained with the periodontal probe do not
normally coincide with the histologic pocket depth
(probe normally penetrates the coronal level of the junctional epithelium, and the
precise location of the probe tip depends on the degree of inflammation of the
underlying connective tissues)
20. Inflamed tissue - less resistance to
probe penetration probe tip either
coincides with or is apical to the
coronal level of connective tissue
attachment
Healed gingiva - increased resistance
to periodontal probing.
21. The disparity between measurements also
depends on the
Probing technique
Probing force
Size of the probe
Angle of insertion of the probe
Precision of the probe calibration
Large standard deviations (0.5 to 1.3
mm) in clinical probing results,
which make detection of small
changes difficult.
22. An ideal periodontal probe should possess specific characteristics:
1. It should be tissue-friendly and not traumatize periodontal tissues during probing.
2. It should be suitable as a measuring instrument.
3. It should be standardized to ensure reproducibility, particularly with respect to recommended
pressure.
4. It should be suitable both for use in the clinical setting where precise data documentation is
required on an individual patient basis, and for screening purposes, as in epidemiology.
5. It should be easy and simple to use and read.
23. Periodontal
probes are
used to
Uses
Detect and measure
periodontal pockets
Clinical attachment loss
Locate calculus
Measure gingival recession
Width of attached gingiva
Size of intraoral lesions
Identify tooth and soft-tissue anomalies
Mucogingival relationships
Bleeding tendencies
24. CLASSIFICATION OF PERIODONTAL
PROBES DEPENDING ON GENERATION
First generation probes:(conventional probes)
Conventional manual probes that do not control
probing force or pressure and that are not
suited for automatic data collection.
Williams periodontal probe
CPITN probe
UNC-15 probe
University of Michigan’O’
probe
Goldman Fox probe
Glickman probe
Merritt A and B probe
Probes
25.
26. Williams periodontal probe
Charles .H.M in 1936 introduced a graduated
periodontal probe known as Williams probe
stainless steel probe with markings
at1mm,2mm,3mm,5mm,7mmm,8mm,9mm,and 10mm
4mm and 6mm readings are missing in this probe to improve
visibility and avoid confusion in reading the markings
The angle between the handle and probe tip is 130 degree
27. CPITN probe
The CPITN is widely used for
screening and monitoring periodontal
findings in patients .
It was designed by George S Beargrie
and Jukka Ainamo in 1978.
Widely used in epidemiological studies
designed for recording the periodontal
findings ,recommended by WHO.
28. The probes have a ball tip of 0.5mm with
a black band from 3.5mm to 5.5mm as
well as black rings at 8.5mm and 11.5mm
weight of the probe is 5gms.
The CPITN probes to identify the
instruments as CPITN –E [epidemiologic
]which have 3.5mm and 5.5mm markings
CPITN-C [clinical ] which have 3.5mm
,5.5mm,8.5mm and 11.5mm markings .
29.
30.
31.
32. NABERS PROBE
Naber s probe is used to detect
and measure involvement of
furcal areas by the periodontal
disease process in multirooted
teeth.
Nabers probe also is used in the
assessment of more complex
clinical cases, including those
with a restorative treatment.
These probes can be color-coded
or without demarcation.
33. 2. Second generation probe: (Constant force probe)
Introduction of constant force or pressure sensitive probes
allowed for improved standardization of probing.
e.g.: Pressure sensitive probe
Constant pressure probe
True pressure sensitive probe
34. The True Pressure Sensitive (TPS) probe is
the prototype for second-generation probes.
Introduced by Hunter in 1994, these probes
have a disposable probing head and a
hemispheric probe tip with a diameter of
0.5 mm.
A controlled probing pressure of 20 gm is
usually applied.
These probes have a visual guide and a
sliding scale where two indicator lines meet
at a specified pressure.
35. In 1977, Armitage designed a pressure-
sensitive probe holder to standardize the
insertion pressure and determine how
accurate probing pressure of 25 pounds
affected the connective-tissue attachment.
In 1978, van der Velden devised a pressure-
sensitive probe with a cylinder and piston
connected to an air-pressure system.
Subsequently, it was modified with a
displacement transducer for electronic
pocket-depth reading.
36. The electronic pressure-sensitive probe, allowing for control
of insertion pressure, was introduced by Polson in 1980.
This probe has a handpiece and a control base that allows the
examiner to control the probing pressure.
The pressure is increased until an audio signal indicates that
the preset pressure has been reached.
Polsons original design was modified by its initial users: that
probe is known as the Yeaple probe, which is used in studies
of dentinal hypersensitivity.
37.
38. 3. Third generation probe:(Automated probes)
Computer assisted direct data capture was an important step in reducing
examiner bias and also allowed for generation probe precision.
e.g.: Toronto probe
Florida probe
Inter probe
Foster Miller probe
39. Foster-Miller probe
The Foster-Miller probe is the prototype of third-generation probes.
Jeffcoat et al in 1986
probe has controlled probing pressure and automated detection of the
cementoenamel junction (CEJ).
The components of the probe are:
pneumatic cylinder
linear variable differential transducer (LVDT),
force transducer
accelerator
probe tip
40. mechanism of action of the Foster-Miller probe is by detection of the CEJ.
The ball tip moves or glides over root surface controlled speed and preset pressure.
Abrupt changes in acceleration of probe movement (recorded on a graph) indicate when it
meets CEJ and when it is stopped at base of the pocket.
Under controlled pressure, probe tip is extended into the pocket and refracted automatically
when base of the pocket is reached.
Position and acceleration-time histories are analyzed to determine attachment level and
pocket depth.
main advantage is the automatic detection of CEJ, which is a better landmark than gingival
margin, because the position of the gingival margin may change depending on inflammation
or recession.
disadvantage is it can deem root roughness or root surface irregularities as the CEJ.
42. Florida probe
florida probe was developed following the criteria defined by the national institute of dental and
craniofacial research for overcoming limitations of periodontal probing .these criteria are
1. easy to use
2.non invasive
3.constant and standardized force
4.light weight
5.easy access to any location around all teeth
6. a guidance system to ensure proper angulation
7.complete sterilization of all portions entering mouth
8.no biohazard from material or electric shock
9. direct electronic reading and digital output
43. Florida Probe
The Florida Probe was devised by Gibbs et al in 1988 .
This probe consists of a
probe handpiece and sleeve;
a displacement transducer
a foot switch
a computer interface/personal computer.
hemispheric probe tip has a diameter of 0.45 mm, and sleeve has a diameter of 0.97 mm .
Constant probing pressure of 15 gm is provided by coil springs inside the handpiece.
edge of the sleeve is reference from which measurements are made, and probe has Williams
markings
measurement of pocket depth is made electronically and transferred automatically to the
computer when the foot switch is pressed
44. The Florida probe measuring a
pocket. When the sleeve reaches
the gingival margin the operator
uses the foot pedal which will
record the measurement.
45. These probes provide a constant probing pressure of 15 gm
They also can record missing teeth, recession, pocket depth, bleeding, suppuration, furcation
involvement, mobility, and plaque assessment.
Each measurement is recorded with potentially 0.2mm accuracy.
Also, there is a chart showing diseased sites, which can be used in patient education.
DISADVANTAGES
It include underestimating deep probing depths a lack of tactile sensitivity.
clinicians need to be trained to operate these probes.
46. Toronto Automated probe,
McCulloch and Birek in1991
It is used for occlusoincisal surface to measure relative clinical attachment levels
This probe was incorporated with a tilt sensor device in its handle which could identify
changes in the angulation of the probe .
The sulcus probing was done with a 0.5mm nickel titanium wire that is extended under air
pressure .
Disadvantage - difficult to reproduce patient head position and in 2nd and 3rd Molar area
47. Inter probe
also called perio probe
Goodson and kondon in 1988
Component - probe tip which is
attached to an optical encoder
transducer element ,a control unit
,memory cards and a foot switch
A fiber bundle transmits light to
the transducer and reflected light
to a signal processor.
48. Probing depth is computed by comparison
of the reflected light signal with the
reference obtained from the zero position
The interprobe is caliberated for a constant
0.3 N probing force and uses a 0.55mm
diameter plastic filament
A plastic filament with a rounded tip
extends from a plastic sheath and
measures pocket depths upto 10mm in
0.5mm increments
49.
50. 4. Fourth generation probes:(Three dimensional probes)
Currently under development, these are aimed at recording sequential probe
positions along a gingival sulcus.
An attempt to extend linear probing in a serial manner to take account of the
continuous and three dimensional pocket that is being examined
51. 5. Fifth generation probe:(Noninvasive Three dimensional probe)
Basically these will add an ultrasound to a fourth generation probes.
If the fourth generation can be made, it will aim in addition to identify
the attachment level without penetrating it.
e.g.: Ultra sonographic probe.
52. Ultra sonographic probe.
It is a non invasive periodontal probing technique
which measures periodontal pocket depth with
identification of junctional epithelial attachment
and cementoenamel junction
devised by Hinders et al
A very narrow beam of high frequency [10-15
MHZ]ultrasonic waves is passed into the gingival
sulcus and echoes of returning waves which are
reflected back from tissues are recorded
Software in computer make image automatically
53. Components
It include transducer which is housed
within a contra angled handpiece at the
base of hollow conical tip ,computer to
record and display the data separate
electron box for water pressure control
and a foot pedal
The hollow conical tip focuses
acoustic beam into periodontal tissue
and the transducer emits and receives
sound waves .
54. Calculus detection probes
detect subgingival calculus by
means of audio readings and
are reported to increase
chances of subgingival
calculus detection.
DetecTar probe (DENTPLY
Professional, Des Moines, IL)
- only calculus detection probe
in market
Calculus Detection
55. DIAMOND PROBE
This is a recently developed
commercially available instrument
developed by the Diamond General
Development Corporation, Ann
Arbour USA.
designed so that it combines the
features of a periodontal probe with
the detection of volatile sulphur
compounds in the periodontal
pocket.
56. Device has a lightweight, well-balanced
handpiece produces audible beep to
signify calculus detection (beep function
can be disengaged).
Probe may augment standard methods of
calculus detection ,it is expensive and the
handpiece is bulkier than a standard
periodontal probe
Potential for false positives and false
negatives; therefore, further research is
required.
Light signal upon detection by
DetecTar. Note thin sheet of calculus
beneath also detected.
57. Periotest
Definition
It is a device used for determining tooth
mobility by measuring the reaction of the
periodontium to a defined percussion force
which is applied to the tooth and delivered
by a tapping instrument
58. PERIOTEST SCALE
Scale Mobility
8 – 9 Clinically firm tooth
10-19 First distinguishable sign of movement
20 -29 Crown deviates within 1mm of its normal
position
30 –
50
Mobility is readily observed
Methodology
1. It measures the reaction of the
periodontium to a predetermined
percussive force applied to the tooth
2. measures the damping characteristic of
periodontium ,instrument is similar in
design and size to a dental hand piece .
3. metal rod is accelerated to a speed of
0.2m/s and maintained at a constant
speed. upon impact tooth is deflected
and the rod is decelerated.
4. Contact time between the taping head
and tooth varies between0.3 -0.2
milliseconds and is shorter for stable
than mobile tooth
ERRORS
Variation in duration
Point of application
Mode of application
Manner and duration
Time of forces
Instability variation
Slippage of device
60. • Dental radiography are the traditional method used to assess the
destruction of alveolar bone associated with Periodontitis.
• Variations in the projection geometry can be reduced by the use of
well standardized long cone parallel radiographic techniques.
61. CONVENTIONAL 2D IMAGING TECHNIQUES
traditional analog imaging modalities are 2d systems that
use image receptors like radiographic films or
intensifying screens. these include
periapical views
panoramic
occlusal
cephalometric radiography.
a digital 2d image is described by an image matrix that
has individual picture elements called pixels.
each pixel has discrete digital value that describes image
intensity at a particular point
62. ADVANCED 2D IMAGING TECHNIQUES
The limitations of traditional 2D imaging
techniques could be overcome with the
evolution of advanced 2D imaging techniques as
illustrated in like: Microradiography,
xeroradiography
stereoscopy
scanography
nuclear medicine.
63. Microradiography
Microradiography is primarily indicated for the quantitative assessment of structural features in mineralized tissues.
It is likely to produce a true radiographic image across the total thickness of the specimen
Two types of microradiography include: Conventional contact microradiography and parallel beam microradiography
which analyses the degree of mineralization of dental tissues like dentinal tubules.
However, their inherent limitations like long exposure time and need for high intensity X-ray sources precludes its use.
64. Xeroradiography
Xeroradiography is a promising imaging technique first introduced by Carbon in 1938.
In 1963, Stronezak first used it in dentistry.
It accomplishes the property of edge enhancement by which small structures and areas of minimal density differences are
better visualized.
excellent aid in evaluating initial osseous changes, assessment of osseous repair after periodontal therapy, and to clearly
visualize the crestal heights
65. Stereoscopy
Stereoscopy is a technique introduced by MacKenzie Davidson in 1988.
It is currently used for examining temporomandibular joint morphology,
evaluation of bony pockets, determination of root configuration needing
endodontic treatment, assessment of relationship of mandibular canals to roots of
unerupted third molars, and to determine the bone contour during dental implants
placement.
Despite its wide applications, stereoscopy is overlooked due to the need for long
exposure time.
66. scanography
Scanography (soredex scanora) is a commercially available X-ray unit capable of
performing both rotational and linear scanography.
It is capable of both posterioanterior and lateral linear scanning of the
maxillofacial complex.
The rotational scanography technique was found to be effective in the assessment
of periodontal disease and in detection of periapical lesions
67. DIGITAL RADIOGRAPHY
refers to a method of capturing radiographic image using a sensor ,breaking it
into electronic pieces and presenting and storing the image using a computer
68.
69. Advantages
1. Easy reproducibility
2. Reduced exposure to radiation
3. Elimination of chemical processing
4. Enhancement of diagnostic image
5. Increased efficiency and speed of image viewing
6. Excellent quality image without loss of quality commonly associated with conventional chemical processing
7. With the aid of the computer detection of defects and 3 dimensional visualization of dental structures based on
radiographic data is possible
70. Disadvantages
.Sensor size is thicker than intraoral films and therefore not patient complaint
.Overexposure and overloading of CCD sensors creating the phenomenon of blooming
Large pixels result in poor resolution and structures may not be represented accurately
.
Loss of image quality and resolution on hard copy print outs when using thermal ,laser or ink jet printers
71. SUBTRACTION RADIOGRAPHY
DEFINITION
Digital Subtraction Radiography (DSR) is a method that can
resolve deficiencies and increase the diagnostic accuracy
HISTORY
Subtraction methods was introduced by B.G.Zeides
Plantes in 1920s
Subtraction radiography was introduced to dentistry in
1980s
72. Subtraction image is performed to suppress background features and to reduce the
background complexity, compress the dynamic range, and amplify small differences by
superimposing the scenes obtained at different times
Subtraction radiography was used to compare standardized radiographs taken at
sequential examination visits.
All unchanged structures were subtracted and these areas were displayed in neutral
gray shade in the subtraction image; while regions that had changed, were displayed in
darker or lighter shades.
73. Changes in the density or volume of bone can be detected as
lighter areas (bone gain)
dark areas (bone loss)
74.
75. APPLICATIONS
study of periapical region
Study of superior surface of condyle
Diagnosis of subtle changes in bone eg. It can be used to assess bone levels
before and after periodontal therapy
76. Computer Assisted Densitometric Image Analysis
(CADIA)
a video camera measures light transmitted through radiograph, and
signals from camera are converted into gray-scale images.
camera is interfaced with an image processor and a computer that allow
storage and mathematical manipulation of the images
77. Offers objective method for following
Alveolar bone density changes quantitatively over time
Higher sensitivity
High degree of reproducibility
Accuracy
78. CROSS-SECTIONAL IMAGING TECHNIQUES
for obtaining cross-sectional information in all planes of interest has
focused towards novel cross-sectional imaging modalities
CT and its other variants namely
Cone beam computed tomography (CBCT)
Quantitative computed tomography (QCT)
Tuned aperture computed tomography (TACT)
Micro focus CT
80. A thin fan beam of X-Rays rotates around patient to generate in one
resolution a thin axial slice of area of interest.
Multiple overlapping axial slices are obtained by several revolution of
X-ray beam until the whole area of interest is covered.
With help of a computer and sophisticated Algorithms these slices are
used to generate a three dimensional digital map of the jaw which help
in evaluation of the implant patient.
81. Specialized software can be used to generate appropriate views that best
depict dimensions of the jaws and location of important anatomic
structures.
Dental Views Obtained From Ct Scan Include:-
1. Axial
2. Panoramic
3. Cross-sectional..
82. DISADVANTAGEs
Specialized equipment and setting.
Radiologists and technicians need to be knowledgeable
Higher radiation dose
It delivers radiation to whole arch.
Metallic restorations can cause ring artifacts that impair
the diagnostic quality of the image, it is challenging to the
patients having heavy metallic restored dentition.
Routine use of CT in dentistry is not accepted due to its
cost, excessive radiation, and general practicality
83. ADVANTAGE Uses
Excellent contrast
Wide field of view
Not operator dependent
Usually good soft tissue
discrimination
Very sensitive for soft tissue
calcification and bone
involvement
Completely eliminates the
superimposition of structure
To assess
anatomy for
peri implant
diagnosis
Ct scanning
helps to
detect space
occupying
lesions
To assess 3 dimensional
space of the maxilla or
mandible
84. CBCT
Cone-Beam Computed Tomography (CBCT) is a new
imaging modality that offers significant advantages for the
evaluation of implant patients
multi- modal image visualization enables treatment platform
that allows assessment of patient’s present condition, planning
and stimulation of treatment options, progress monitoring and
evaluation of outcomes
85. In comparison with conventional fan-beam
or spiral-scan geometries, cone-beam
geometry has higher efficiency in X-ray use,
inherent quickness in volumetric data
acquisition, and potential for reducing cost
of CT.
The cone beam technique requires only a
single scan to capture the entire object
known as field of view which refers to the
area of the anatomy that is captured with a
cone of X-rays
86. Indications of CBCT
Evaluation of the jaw bones which includes the following:
Pathology
Bony and soft tissue lesions
Periodontal assessment
Endodontic assessment
Alveolar ridge resorption
Recognition of fractures and structural maxillofacial deformities
Assessment of inferior alveolar nerve before extraction of mandibular
third molar impactions
Orthodontic evaluation—3D cephalometry
temporomandibular joint evaluation
Implant placement and evaluation
Airway assessment
for 3D reconstructions
87. Advantages of CBCT
rapid scan time as compared with panoramic radiography.
complete 3D reconstruction and display from any angle
beam collimation enables limitation of radiation to the area of interest.
Image accuracy produces images with submillimeter isotropic voxel resolution ranging from 0.4 mm to as low as 0.076 mm.
Patient radiation dose is five times lower than normal CT, as the exposure time is approximately 18 seconds, that is, one-
seventh the amount compared with the conventional medical CT.
CBCT units reconstruct the projection data to provide interrelational images in three orthogonal planes (axial, sagittal, and
coronal).
88. Multiplanar reformation is possible by sectioning volumetric datasets nonorthogonally.
Multiplanar image can be “thickened” by increasing the number of adjacent voxels included in the
display, referred to as ray sum.
3D volume rendering is possible by direct or indirect technique.
The three positioning beams make patient positioning easy. Scout images enable even more accurate
positioning.
Reduced image artifacts: CBCT projection geometry, together with fast acquisition time, results in a low
level of metal artifact in primary and secondary reconstructions.
DISADVANTAGES
The only disadvantage is its cost. But considering the enormous benefits, this cost effect can be overlooked.
89. Cone beam volumetric tomography (CBVT)
Another variant of CT is cone beam volumetric tomography (CBVT)
This obviates the necessity for surgical re-entry to assess outcome of periodontal
bone grafting.
It produces images that have high resolution and accuracy for measuring
regenerative therapy outcomes like direct bone fill and defect resolution
90. Quantitative computed tomography (QCT)
Quantitative computed tomography (QCT) bone densitometry is a clinically proven method of measuring
bone mineral density (BMD)
QCT is used primarily in the diagnosis and management of osteoporosis and other disease states that may
be characterized by abnormal BMD, as well as to monitor response to therapy for these conditions.
91. Micro focus CT
Micro focus CT is a new type of imaging, with special resolution of <10
mm to study trabecular bone structure enamel thickness, calcification of
human teeth ,dental root canal morphology.
Identification of bone resorption, bone to implant interface, and
visualization of fine trabecular pattern of newly formed bone.
92. Optical coherence tomography (OCT)
Optical coherence tomography (OCT) generates cross
sectional images of biological tissues using a near
infrared light source.
The light is able to penetrate the tissues without
biologically harmful effects.
93. Difference in the reflection of the light are
used to generate a signal that corresponds
to the morphology and composition of the
underlying tissues.
Feasibility of its clinical use was
demonstrated by capturing high resolution
images of oral structures including soft
tissues and hard tissues boundaries of the
periodontium.
94. Magnetic resonance imaging [MRI]
technique relies on the phenomenon of nuclear construct resonance
to produce a signal that can be used to construct an image
Purpose
To use a magnetic field to produce an image that is related to the
protons or water in organ. Soft tissues are more strongly imaged than
calcified tissues
95. Advantages
1. No ionizing radiation
2. No biological effects
3. Higher soft tissue contrast
4. Blood vessels clearly seen
5. High resolution images can be
constructed in all planes
6. MR image of periodontal tissues
before and after initial therapy might
be a useful tool for quantification of
periodontal inflammation
Limitations
1. Expensive procedure
2. Expensive equipment
3. Claustrophobic procedure
4. Relatively long imaging times
5. Metallic objects in the oral cavity such as
appliances ,crowns etc may cause artifacts
96. Radioisotope scanning
It is based on the principle of nuclear medicine absorption
of a material that emits radiation ,detection and display of
radiation in such a way so as to provide anatomical
,physiological or pathological information
97. Uses
1. Helps in detection of certain tumors
2. To detect the areas of altered bone
metabolism due to active bone loss
3. useful for clinical trials or bone
marrow transplantation that requires
immediate disclosure of possible
occult infections
Advantage
Pathophysiological information is good for the assessment of
metastatic spread.
Disadvantage
Poor anatomical discrimination
98. Ultrasonography
Ultrasound image relies upon the transmission of high frequency sound ,which is attenuated as it passes through
tissue at a rate dependent upon the acoustic properties of that tissue and upon frequency of the incoming
waveform.
Uses
1. It is useful in detecting space occupying lesion .
2. Presence of solid or cystic masses can be detected with ultrasound
3. Can detect masses present within the gland and outside the gland
99. Advantage
1. non ionizing radiation
2. Good soft tissue discrimination
3. Excellent sensitivity for mass lesions
4. Easy and rapid scanning of most of the plane
Disadvantage
Operator dependant
Limited bone formation
Poor visualization of deep structures
100. Conclusion
Although there are many potential markers for periodontal disease activity and
progression, still numerous features hamper the ability to use them as diagnostic tests of
proven utility.
There is still a lack of a proven gold standard of disease progression and thus the
correlation of these potential markers with proven clinical attachment loss may be a
potential confounder in any proposed test.
After all these years of intensive research we still lack a proven diagnostic test that has
demonstrated high predictive value for disease progression, has a proven impact on
disease incidence and prevalence and is simple, safe and cost effective.
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