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.
The document discusses the history and principles of periodontal plastic surgery, which aims to correct anatomical defects of the gingiva, alveolar mucosa, or bone through procedures like gingival augmentation and root coverage. Various surgical techniques are described for increasing attached gingiva, such as free gingival autografts, free connective tissue autografts, and apically positioned flaps. The healing process and indications for different procedures are also reviewed.
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.
This document discusses the historical background and various methods of root biomodification, which involves chemically or mechanically modifying the root surface to promote periodontal regeneration. It describes how citric acid, tetracycline, fibronectin, and EDTA work to demineralize and detoxify the root surface in order to remove the smear layer and expose collagen fibers, making the surface more biocompatible and conducive to new attachment of periodontal tissues. Register and Burdick's 1975 technique using citric acid application for 2-3 minutes is outlined, along with modifications by Miller. The mechanisms and benefits of different agents are explained.
Effects of restorative procedure on periodontiumParth Thakkar
The document discusses several factors related to restoring teeth and maintaining periodontal health. Restorative procedures should aim to place margins in a supragingival location to avoid biological width violations that can cause inflammation and bone loss. Crown contours and materials should facilitate plaque removal. Esthetic considerations include maintaining ideal embrasure forms between teeth. Occlusion should distribute forces across all teeth to prevent trauma from excessive forces.
This document discusses various indices used to assess oral health conditions. It defines an index and lists ideal requisites of an index. It then describes several commonly used indices to measure gingival inflammation, gingival bleeding, periodontal diseases, oral hygiene, plaque, dentin hypersensitivity, and dental fluorosis. Examples include the Gingival Index, Sulcus Bleeding Index, Community Periodontal Index of Treatment Needs, Oral Hygiene Index, and Plaque Index. The indices provide quantitative and standardized measures of oral conditions for research, clinical trials, and evaluating treatment needs in individuals and populations.
This document discusses patterns of bone destruction in periodontal disease. It covers various causes of bone loss such as the extension of gingival inflammation, trauma from occlusion, and systemic disorders. Factors that determine bone destruction include normal bone variation, exostoses, buttressing bone formation, and food impaction. Common bone destruction patterns include horizontal loss, vertical defects, intrabony defects of one to three walls, furcation involvement, osseous craters, and ledges. Systemic conditions like osteoporosis and Paget's disease can also cause alveolar bone destruction.
advanced diagnostic aids in periodonticsMehul Shinde
Advanced diagnostic aids provide more precise tools and technologies for diagnosis. New probes allow for controlled pressure and automated measurement. Digital radiography provides advantages like reduced radiation dose and immediate imaging. Techniques like digital subtraction radiography and cone-beam computed tomography improve detection of bone changes over time. Overall, advances in clinical, radiographic, microbiological and host-response assessments enhance diagnosis of disease presence, type and progression.
The document discusses the history and principles of periodontal plastic surgery, which aims to correct anatomical defects of the gingiva, alveolar mucosa, or bone through procedures like gingival augmentation and root coverage. Various surgical techniques are described for increasing attached gingiva, such as free gingival autografts, free connective tissue autografts, and apically positioned flaps. The healing process and indications for different procedures are also reviewed.
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.
This document discusses the historical background and various methods of root biomodification, which involves chemically or mechanically modifying the root surface to promote periodontal regeneration. It describes how citric acid, tetracycline, fibronectin, and EDTA work to demineralize and detoxify the root surface in order to remove the smear layer and expose collagen fibers, making the surface more biocompatible and conducive to new attachment of periodontal tissues. Register and Burdick's 1975 technique using citric acid application for 2-3 minutes is outlined, along with modifications by Miller. The mechanisms and benefits of different agents are explained.
Effects of restorative procedure on periodontiumParth Thakkar
The document discusses several factors related to restoring teeth and maintaining periodontal health. Restorative procedures should aim to place margins in a supragingival location to avoid biological width violations that can cause inflammation and bone loss. Crown contours and materials should facilitate plaque removal. Esthetic considerations include maintaining ideal embrasure forms between teeth. Occlusion should distribute forces across all teeth to prevent trauma from excessive forces.
This document discusses various indices used to assess oral health conditions. It defines an index and lists ideal requisites of an index. It then describes several commonly used indices to measure gingival inflammation, gingival bleeding, periodontal diseases, oral hygiene, plaque, dentin hypersensitivity, and dental fluorosis. Examples include the Gingival Index, Sulcus Bleeding Index, Community Periodontal Index of Treatment Needs, Oral Hygiene Index, and Plaque Index. The indices provide quantitative and standardized measures of oral conditions for research, clinical trials, and evaluating treatment needs in individuals and populations.
This document discusses patterns of bone destruction in periodontal disease. It covers various causes of bone loss such as the extension of gingival inflammation, trauma from occlusion, and systemic disorders. Factors that determine bone destruction include normal bone variation, exostoses, buttressing bone formation, and food impaction. Common bone destruction patterns include horizontal loss, vertical defects, intrabony defects of one to three walls, furcation involvement, osseous craters, and ledges. Systemic conditions like osteoporosis and Paget's disease can also cause alveolar bone destruction.
advanced diagnostic aids in periodonticsMehul Shinde
Advanced diagnostic aids provide more precise tools and technologies for diagnosis. New probes allow for controlled pressure and automated measurement. Digital radiography provides advantages like reduced radiation dose and immediate imaging. Techniques like digital subtraction radiography and cone-beam computed tomography improve detection of bone changes over time. Overall, advances in clinical, radiographic, microbiological and host-response assessments enhance diagnosis of disease presence, type and progression.
The modified Widman flap is a periodontal surgical technique used to obtain access to the root surface and allow for intimate postoperative adaptation of healthy connective tissue and epithelium to the root surface. Key aspects include:
1. Incisions are made internally and intracrevicularly to minimize tissue loss and gingival shrinkage. Vertical releasing incisions are usually not used.
2. The goal is access for root debridement rather than pocket elimination. Minimal flap elevation of 1-2mm is done to access root surfaces.
3. It is indicated for mild to moderate periodontitis with pocket depths up to 6mm and minimal inflammation. Primary intention healing occurs.
This document discusses various surgical techniques for preserving the interdental papilla during periodontal regeneration procedures. It describes the conventional papilla preservation flap technique introduced by Takei in 1985, as well as several modifications including the modified papilla preservation flap, simplified papilla preservation flap, interproximal tissue maintenance technique, and whale's tail technique. The advantages and disadvantages of each technique are summarized. A novel entire papilla preservation technique introduced in 2015 is also outlined, which aims to completely preserve the interdental papilla.
General principles of Periodontal surgeryJignesh Patel
The document discusses general principles of periodontal surgery. It covers patient preparation, indications and contraindications for surgery, local anesthesia techniques, hemostasis methods, periodontal dressings, postoperative pain management, and follow-up evaluations. The goals of periodontal surgery are to gain access for root debridement, establish favorable gingival contours, facilitate plaque control, and potentially regenerate lost periodontal tissues. Proper surgical techniques and postoperative care are essential for healing.
Host microbe interaction in periodontal diseaseDr Saif khan
Periodontal diseases like gingivitis and periodontitis are inflammatory responses to microorganisms in dental plaque that lead to tissue destruction and bone loss. They develop through an interaction between the host and microbes, where microbes can directly or indirectly cause tissue damage by stimulating the host response. The host response is mediated by genetic factors and aims to prevent local infections from becoming systemic, but can also contribute to local tissue destruction through the release of proteinases, cytokines, and prostaglandins.
This document outlines the phases of periodontal therapy, including:
1) Preliminary phase focusing on emergencies and extractions.
2) Nonsurgical phase involving plaque control, non-surgical treatments like scaling and root planing.
3) Surgical phase using various periodontal surgeries and other treatments like implants and endodontics.
4) Restorative phase for final restorations and prosthodontics.
5) Maintenance phase for long-term supportive periodontal therapy.
Surgical periodontal therapy aims to eliminate pathologic changes, create a stable periodontium, and promote regeneration through techniques like pocket reduction surgeries and correction of anatomic defects
Periodontal pockets can be classified in several ways, including by their relationship to the alveolar crest (suprabony or intrabony), the number of tooth surfaces involved (simple, compound, or complex), and the number of remaining osseous walls in intrabony pockets. Periodontal abscesses are acute or chronic localized purulent infections that develop from preexisting periodontal pockets. They are typically treated first by establishing drainage through the pocket or incision, along with antibiotics in some cases. Further treatment involves scaling and root planing or surgery to address the underlying chronic periodontitis.
The document outlines the phases and procedures involved in developing and implementing a treatment plan for periodontal therapy. It discusses establishing diagnoses and prognoses, designing a master plan that sequences nonsurgical and surgical treatments, restorative work, maintenance, and addressing systemic factors. The goal is to create a healthy periodontium and functioning dentition through elimination of irritants and correction of underlying issues causing inflammation and tissue destruction.
Biological considerations of dental implantFiras Kassab
This document provides an overview of dental implants and osseointegration in 3 stages:
1) It defines key implant terms and classifications.
2) It describes different implant designs, surfaces, and modification techniques.
3) It explains the 3-month process of bone healing and remodeling around implants leading to successful osseointegration, including initial woven bone formation, lamellar bone deposition, and ongoing remodeling.
This document defines and outlines common iatrogenic (treatment-caused) factors that can contribute to periodontal disease. It discusses 10 main factors: overhanging or subgingival restoration margins, poor restoration contours, materials and procedures, partial denture design, malocclusion, orthodontic therapy, impacted tooth extractions, habits like toothbrushing, chemical injuries, radiation therapy, and laser use complications. Each factor is described in terms of how it can disrupt plaque control and the periodontal environment, leading to issues like gingivitis, recession, and bone loss. Prevention methods are also outlined.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
REFERENCES TAKEN FROM CARRANZA'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND LINDHE'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRY. CONTAINS ENOUGH AND MORE DETAILS OF THIS TOPIC FOR BDS STUDENTS.HOPE THIS PRESENTATION WILL HELP U GAIN SOME KNOWLEDGE ABOUT PERIODONTAL PLASTIC AND ESTHETIC DENTISTRY.
This document discusses various periodontal surgical procedures performed by general practitioners, including gingivectomy, modified Widman flap, open flap debridement, and apically positioned flap. It provides details on the objectives, indications, techniques and drawbacks of each procedure. Principles of periodontal surgery are outlined, emphasizing goals of accessing roots, establishing favorable contours, facilitating oral hygiene and regenerating lost periodontium. Factors for proper healing and potential post-surgical complications are also summarized.
This document discusses periodontal regeneration and the various factors involved. It begins by defining key terminology related to grafting and regeneration. It then discusses the biology and objectives of periodontal regeneration, including the ideal outcome of new attachment formation and factors that can influence outcomes. The document outlines various techniques for periodontal regeneration including non-graft associated approaches involving removal of epithelium and surgical techniques, as well as graft-associated approaches using various graft materials. Requirements for predictable regeneration and assessment methods are also summarized.
Dental implants are placed into the jawbone to support crowns, bridges, dentures or facial prosthetics. There are several types but they generally involve a titanium implant being surgically placed into the jawbone in either a one-stage or two-stage procedure. In a two-stage procedure, the top of the implant is submerged under gingiva and uncovered in a second surgery once integrated. Proper placement, biocompatible materials, and avoiding overheating the bone are important for integration. Implants can replace single or multiple teeth and have advantages over other options but also have higher costs and longer treatment times.
Various Plaque Hypothesis are proposed to prove how plaque becomes pathogenic and cause periodontitis. Helpful in understanding pathogenesis of periodontitis especially how Gingivitis change to Periodontitis. All the details have been added and made in easy language to understand.
Useful for BDS and MDS students
Definition of periodontal pocket, classification, Histopathology of periodontal pocket, microflora involved, pathogenesis, periodontal pocket as a healing lesion, microtopography of root surface, treatment of periodontal pocket
Desquamative gingivitis is a condition characterized by redness, peeling, and sores of the gums. It is not a specific disease but rather a gingival response that can be associated with various conditions. These conditions include autoimmune diseases that affect the skin and mucous membranes like pemphigus vulgaris, bullous pemphigoid, and lichen planus. Desquamative gingivitis presents clinically as fiery red, friable gums that desquamate or peel easily, causing soreness especially with spicy or acidic foods or toothbrushing. A biopsy including a direct immunofluorescence test may be needed to identify the underlying cause and guide treatment, which typically
Viruses play a role in various periodontal diseases. The document discusses several viruses that can cause periodontal disease, including herpes simplex virus, varicella zoster virus, Epstein-Barr virus, human cytomegalovirus, hepatitis viruses, and human immunodeficiency virus. It provides details on the classification, transmission, pathogenesis, clinical manifestations, and treatment of the diseases associated with these viruses. The document concludes that viruses have the potential to extend our understanding of the mechanisms of periodontal tissue breakdown and should be considered contributory causes of periodontal disease along with bacteria.
Periodontal medicine is the study of the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Periodontitis has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help improve glycemic control in diabetic patients and reduce systemic inflammation.
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.
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.
The modified Widman flap is a periodontal surgical technique used to obtain access to the root surface and allow for intimate postoperative adaptation of healthy connective tissue and epithelium to the root surface. Key aspects include:
1. Incisions are made internally and intracrevicularly to minimize tissue loss and gingival shrinkage. Vertical releasing incisions are usually not used.
2. The goal is access for root debridement rather than pocket elimination. Minimal flap elevation of 1-2mm is done to access root surfaces.
3. It is indicated for mild to moderate periodontitis with pocket depths up to 6mm and minimal inflammation. Primary intention healing occurs.
This document discusses various surgical techniques for preserving the interdental papilla during periodontal regeneration procedures. It describes the conventional papilla preservation flap technique introduced by Takei in 1985, as well as several modifications including the modified papilla preservation flap, simplified papilla preservation flap, interproximal tissue maintenance technique, and whale's tail technique. The advantages and disadvantages of each technique are summarized. A novel entire papilla preservation technique introduced in 2015 is also outlined, which aims to completely preserve the interdental papilla.
General principles of Periodontal surgeryJignesh Patel
The document discusses general principles of periodontal surgery. It covers patient preparation, indications and contraindications for surgery, local anesthesia techniques, hemostasis methods, periodontal dressings, postoperative pain management, and follow-up evaluations. The goals of periodontal surgery are to gain access for root debridement, establish favorable gingival contours, facilitate plaque control, and potentially regenerate lost periodontal tissues. Proper surgical techniques and postoperative care are essential for healing.
Host microbe interaction in periodontal diseaseDr Saif khan
Periodontal diseases like gingivitis and periodontitis are inflammatory responses to microorganisms in dental plaque that lead to tissue destruction and bone loss. They develop through an interaction between the host and microbes, where microbes can directly or indirectly cause tissue damage by stimulating the host response. The host response is mediated by genetic factors and aims to prevent local infections from becoming systemic, but can also contribute to local tissue destruction through the release of proteinases, cytokines, and prostaglandins.
This document outlines the phases of periodontal therapy, including:
1) Preliminary phase focusing on emergencies and extractions.
2) Nonsurgical phase involving plaque control, non-surgical treatments like scaling and root planing.
3) Surgical phase using various periodontal surgeries and other treatments like implants and endodontics.
4) Restorative phase for final restorations and prosthodontics.
5) Maintenance phase for long-term supportive periodontal therapy.
Surgical periodontal therapy aims to eliminate pathologic changes, create a stable periodontium, and promote regeneration through techniques like pocket reduction surgeries and correction of anatomic defects
Periodontal pockets can be classified in several ways, including by their relationship to the alveolar crest (suprabony or intrabony), the number of tooth surfaces involved (simple, compound, or complex), and the number of remaining osseous walls in intrabony pockets. Periodontal abscesses are acute or chronic localized purulent infections that develop from preexisting periodontal pockets. They are typically treated first by establishing drainage through the pocket or incision, along with antibiotics in some cases. Further treatment involves scaling and root planing or surgery to address the underlying chronic periodontitis.
The document outlines the phases and procedures involved in developing and implementing a treatment plan for periodontal therapy. It discusses establishing diagnoses and prognoses, designing a master plan that sequences nonsurgical and surgical treatments, restorative work, maintenance, and addressing systemic factors. The goal is to create a healthy periodontium and functioning dentition through elimination of irritants and correction of underlying issues causing inflammation and tissue destruction.
Biological considerations of dental implantFiras Kassab
This document provides an overview of dental implants and osseointegration in 3 stages:
1) It defines key implant terms and classifications.
2) It describes different implant designs, surfaces, and modification techniques.
3) It explains the 3-month process of bone healing and remodeling around implants leading to successful osseointegration, including initial woven bone formation, lamellar bone deposition, and ongoing remodeling.
This document defines and outlines common iatrogenic (treatment-caused) factors that can contribute to periodontal disease. It discusses 10 main factors: overhanging or subgingival restoration margins, poor restoration contours, materials and procedures, partial denture design, malocclusion, orthodontic therapy, impacted tooth extractions, habits like toothbrushing, chemical injuries, radiation therapy, and laser use complications. Each factor is described in terms of how it can disrupt plaque control and the periodontal environment, leading to issues like gingivitis, recession, and bone loss. Prevention methods are also outlined.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
REFERENCES TAKEN FROM CARRANZA'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND LINDHE'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRY. CONTAINS ENOUGH AND MORE DETAILS OF THIS TOPIC FOR BDS STUDENTS.HOPE THIS PRESENTATION WILL HELP U GAIN SOME KNOWLEDGE ABOUT PERIODONTAL PLASTIC AND ESTHETIC DENTISTRY.
This document discusses various periodontal surgical procedures performed by general practitioners, including gingivectomy, modified Widman flap, open flap debridement, and apically positioned flap. It provides details on the objectives, indications, techniques and drawbacks of each procedure. Principles of periodontal surgery are outlined, emphasizing goals of accessing roots, establishing favorable contours, facilitating oral hygiene and regenerating lost periodontium. Factors for proper healing and potential post-surgical complications are also summarized.
This document discusses periodontal regeneration and the various factors involved. It begins by defining key terminology related to grafting and regeneration. It then discusses the biology and objectives of periodontal regeneration, including the ideal outcome of new attachment formation and factors that can influence outcomes. The document outlines various techniques for periodontal regeneration including non-graft associated approaches involving removal of epithelium and surgical techniques, as well as graft-associated approaches using various graft materials. Requirements for predictable regeneration and assessment methods are also summarized.
Dental implants are placed into the jawbone to support crowns, bridges, dentures or facial prosthetics. There are several types but they generally involve a titanium implant being surgically placed into the jawbone in either a one-stage or two-stage procedure. In a two-stage procedure, the top of the implant is submerged under gingiva and uncovered in a second surgery once integrated. Proper placement, biocompatible materials, and avoiding overheating the bone are important for integration. Implants can replace single or multiple teeth and have advantages over other options but also have higher costs and longer treatment times.
Various Plaque Hypothesis are proposed to prove how plaque becomes pathogenic and cause periodontitis. Helpful in understanding pathogenesis of periodontitis especially how Gingivitis change to Periodontitis. All the details have been added and made in easy language to understand.
Useful for BDS and MDS students
Definition of periodontal pocket, classification, Histopathology of periodontal pocket, microflora involved, pathogenesis, periodontal pocket as a healing lesion, microtopography of root surface, treatment of periodontal pocket
Desquamative gingivitis is a condition characterized by redness, peeling, and sores of the gums. It is not a specific disease but rather a gingival response that can be associated with various conditions. These conditions include autoimmune diseases that affect the skin and mucous membranes like pemphigus vulgaris, bullous pemphigoid, and lichen planus. Desquamative gingivitis presents clinically as fiery red, friable gums that desquamate or peel easily, causing soreness especially with spicy or acidic foods or toothbrushing. A biopsy including a direct immunofluorescence test may be needed to identify the underlying cause and guide treatment, which typically
Viruses play a role in various periodontal diseases. The document discusses several viruses that can cause periodontal disease, including herpes simplex virus, varicella zoster virus, Epstein-Barr virus, human cytomegalovirus, hepatitis viruses, and human immunodeficiency virus. It provides details on the classification, transmission, pathogenesis, clinical manifestations, and treatment of the diseases associated with these viruses. The document concludes that viruses have the potential to extend our understanding of the mechanisms of periodontal tissue breakdown and should be considered contributory causes of periodontal disease along with bacteria.
Periodontal medicine is the study of the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Periodontitis has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help improve glycemic control in diabetic patients and reduce systemic inflammation.
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.
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.
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.
Advanced radiographic aids in periodonticsSwati Gupta
Digital radiography and imaging techniques like digital subtraction radiography, computer-assisted densitometric image analysis, and computed tomography provide more accurate and quantitative assessments of periodontal bone levels compared to conventional radiography. These advanced techniques allow for early detection of bone loss, longitudinal monitoring of treatment outcomes, and three-dimensional imaging. However, many require specialized equipment and high levels of standardization for calibration.
1. The document discusses various advances in clinical diagnosis, radiographic assessment, microbiological analysis, and characterization of the host response that can aid in the diagnosis of periodontitis.
2. New diagnostic tools discussed include methods to analyze gingival bleeding, temperature, probing depth, digital radiography, subtraction radiography, microbiological assays, and markers in gingival crevicular fluid and saliva.
3. These diagnostic advances provide more sensitive, specific, and quantitative methods for detecting periodontal disease activity and microbial pathogens compared to traditional clinical and radiographic exams.
This document provides an overview of periodontal probes, including their history, uses, classifications, and related studies. Periodontal probes are calibrated instruments used to measure pocket depth and determine pocket configuration. Several generations of probes have been developed over time, with modifications including standardized tip diameters and shapes, millimeter markings, and the incorporation of pressure sensors. Current probes range from conventional manual probes to computerized probes that can precisely measure probing force and position. Probes are a key diagnostic tool in periodontal examinations and assessments of treatment outcomes.
The document discusses the Basic Periodontal Examination (BPE), a screening tool used to assess periodontal disease levels and treatment needs. The BPE divides the mouth into sextants and codes pockets and furcations from 0-4 based on probing depth. A score of 3 or 4 indicates need for detailed charting or possible specialist referral. The BPE is useful for screening and monitoring but not assessing treatment response. Interpretation depends on individual factors, and radiographs are typically needed with scores of 3 or 4.
This document provides an overview of the microbiology of periodontal diseases. It discusses the colonization of bacteria in the oral cavity from birth and the hundreds of bacterial species that can colonize the adult mouth. It describes the classification of bacteria based on morphology, staining characteristics, and culturing characteristics. The document discusses the biofilm formation on tooth surfaces and how it protects colonizing bacteria. It also reviews the historical perspectives on periodontal disease-causing bacteria from the 1880s to 1930s and the return to the concept of specific microbial etiology in the 1960s.
This document provides an overview of halitosis (bad breath), including its classification, etiology, diagnosis, and management. It discusses the role of volatile sulfur compounds and certain bacteria in causing halitosis. Diagnostic tools include organoleptic measurement, gas chromatography, and volatile sulfide monitoring to detect these compounds. Treatment involves identifying and addressing the underlying causes, such as periodontal disease, dry mouth, dental caries, or systemic conditions. Preventive measures focus on proper oral hygiene and avoiding foods that can cause temporary halitosis.
The document discusses treatment planning in periodontics. It begins by defining treatment planning and outlining the short and long-term goals. These include eliminating infection and inflammation and reconstructing a healthy dentition. The treatment plan is the blueprint and involves decisions about emergency treatment, extractions, nonsurgical and surgical therapies, restorations, and maintenance. Phases of treatment are discussed including preliminary, nonsurgical, surgical, and maintenance phases. Factors in deciding whether to extract or preserve a tooth are also outlined.
The periodontal examination should be systematic, starting in the molar region in either maxilla or mandible and proceeding around the arch. It is important to detect the earliest signs of gingival and periodontal disease.
Diagnostic methods for detecting periodontal diseasesUsama Madany
This document discusses various diagnostic methods for detecting periodontal diseases. It describes the following methods:
1. A thorough questionnaire and cursory examination to obtain medical history and look for signs of gingival issues.
2. The O'Leary screening examination to diagnose periodontitis and monitor previously treated patients, which involves probing and assessing gingival health and periodontal pockets.
3. A detailed periodontal examination involving clinical and radiographic exams, assessment of occlusion, tooth mobility, and vitality, and a periodontal exam measuring pocket depth and attachment levels.
Chronic periodontitis is an inflammatory disease that causes the destruction of the tissues that support the teeth. It is caused by bacterial plaque accumulating at and below the gumline. The disease is characterized by pocket formation, attachment loss, and bone loss. It is usually slowly progressive and can range from mild to severe. Diagnosis involves measuring pocket depths, attachment levels, bleeding, and bone loss visible on radiographs. Risk factors include poor oral hygiene, smoking, diabetes, and genetic factors. Treatment aims to eliminate plaque and bacteria through nonsurgical methods like scaling and root planing or sometimes surgical procedures to reduce pocket depths and regenerate lost tissues.
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.
ADVANCED CLINICAL AND RADIOGRAPHIC DIAGNOSTIC AIDS (2).pptxveena621629
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.
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.
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.
This document discusses advances in periodontal diagnosis, from early methods relying on physical signs and symptoms to newer techniques utilizing technology. It covers developments in clinical diagnosis including tools to assess inflammation like gingival bleeding tests and crevicular fluid flow measurements. Advances in imaging like dental X-rays are discussed. The document also explores emerging ways of characterizing host response and genetic factors. A significant portion reviews the evolution of periodontal probes from manual to electronic versions that provide more standardized, precise measurements.
This document discusses advances in periodontal diagnostic techniques. It begins by describing traditional diagnostic methods based on physical examination and signs/symptoms. It then explores developments in clinical diagnosis including methods to evaluate inflammation like gingival bleeding and crevicular fluid flow. The document also examines advances in imaging technologies and characterization of host response. Advances in probing devices are covered, moving from manual probes to computerized probes that provide precise, standardized measurements with controlled probing force.
This document discusses changing perspectives on the treatment of periodontal disease, from the nonspecific plaque hypothesis (NSPH) to the specific plaque hypothesis (SPH). The NSPH assumed all plaque was equally pathogenic, while studies since the 1970s have demonstrated the microbiological specificity of disease-associated bacteria. The SPH recognizes that only certain "pathogenic" plaques cause infections. Diagnosis under SPH involves detecting these anaerobic bacteria to determine who needs treatment, which is then targeted to eliminate the specific pathogens. Several studies found nonsurgical treatments like scaling and root planing were often as effective as surgical treatments for periodontal pockets. Monitoring treatment success using follow-up bacteriology is important under the SPH.
Although there are many potential markers for periodontal disease activity and progression, numerous features still hamper the ability to use them as diagnostic tests of proven utility. After all these years of intensive research, we still lack a proven diagnostic test that has demonstrated high predictive value for disease progression.
- A biopsy is the removal of tissue for diagnostic examination and includes oral cytology, aspiration biopsy, incisional biopsy, and excisional biopsy.
- It is important to properly prepare for and handle biopsy specimens to avoid altering the tissue and properly orient the pathologist.
- If biopsy results do not match the clinical impression, the biopsy should be repeated at an oral pathology expert to accurately diagnose the lesion.
The document discusses various aspects of biopsy procedures including:
1. Biopsy is the removal of tissue for microscopic examination and diagnosis to help establish a histological diagnosis, prognosis, and treatment plan.
2. There are various biopsy techniques including incisional, excisional, punch, and aspiration biopsies. Each have advantages and disadvantages for different clinical situations.
3. Proper biopsy technique and handling of specimens is important to avoid artifacts and allow for an accurate histological assessment.
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.
- Conventional periodontal diagnosis has limitations as it only measures current signs of inflammation and damage, but cannot identify ongoing destruction or consider other factors.
- Advanced diagnostic techniques include assessing gingival bleeding, temperature, probing depths, and microbiology to provide more information on disease activity, progression, and host susceptibility.
- Generations of probes have improved from manual to automated and aim to standardize force and precision while making measurements electronic and digitally accessible. The Florida probe system was an early automated probe but newer probes aim to improve tactile sensitivity and account for variability between sites.
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.
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.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. Oral biopsy; why, when, and how? Biopsy is the removal of the tissue from the living organism for the purpose of microscopic examination and diagnosis. Looking for a definitive diagnosis is the aim of biopsy. Types of Biopsy include incisional, excisional, drill, fine needle and frozen section biopsy.
Periodontal probing and techniques involve using calibrated probes to measure pocket depth and determine periodontal pocket configuration. There have been several generations of probes developed with improvements in standardization, precision, and automation. First generation probes were manual and included the Williams probe. Second generation probes aimed to standardize pressure, like the TPS probe. Third generation probes were automated, like the Florida Probe. Fourth generation probes utilized 3D technology while fifth generation probes combine ultrasound for more accurate measurement without pocket penetration. Studies show electronic probes provide more reproducible measurements than manual probes, though manual probes can have good reproducibility as well depending on the examiner.
3. Introduction
• Periodontal disease is considered a site
specific disease characterized by local
inflammatory reaction to bacterial infection.
• The attempts to identify specific bacteria,
specific inflammatory cells or molecules, or
specific breakdown products have been the
soul reason for the advances in diagnostic
methodology.
3Dr Ashish U. Bisane
4. Gingival Bleeding
• Gingival Inflammation is diagnosed based upon:
1. Gingival Bleeding on Probing (Objective sign)
2. Gingival Redness
3. Gingival edema/swelling
• Gingival bleeding is a good indicator of the presence 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. (Greenstein G, 1981; Polson AM, 1985)
5Dr Ashish U. Bisane
5. • 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.
• Photomicrograph of
thin, microulcerated
epithelial lining of the
soft tissue wall of an
infected pocket. Such
sites readily bleed when
gently probed
6Dr Ashish U. Bisane
6. • Subjects who refrain from normal oral hygiene procedures have a resultant increase
in plaque accumulation and demonstrate a concomitant increase in gingival
bleeding as gingivitis develops over a 2-3 week period. (Greenstein G, 1981)
• Lang et al 1991, in a retrospective study reported that sites that bled on probing at
several visits had a greater probability of losing attachment than those that bled at
one visit or did not bleed.
• However, well controlled longitudinal studies investigated the predictive values of
such clinical sign, trying to correlate them with attachment loss, but failed to
demonstrate a significant correlation between bleeding on probing and other
clinical signs and subsequent loss of attachment. (Badersten.A, 1985; Haffajee.A.D,
1983)
7Dr Ashish U. Bisane
7. • Drawbacks:
1. Healthy sites may bleed on probing as any force
greater than 0.25N evokes bleeding even in an intact
periodontium.
2. Relationship to disease progress is unclear.
3. Signs of inflammation are inhibited in smokers
(Nair.P, 2003).
8Dr Ashish U. Bisane
8. (Sub)Gingival Temperature
• Kung et al, 1990; demonstrated that the
subgingival temperature at diseased sites is
increased compared with healthy sites and that a
natural anteroposterior temperature gradient exists
within the dental arches.
• Kung et al, 1990; thus, claimed that thermal
probes are sensitive diagnostic devices for
measuring early inflammatory changes in the
gingival tissues.
9Dr Ashish U. Bisane
9. Perio-Temp (Thermal
Periodontal Probing System)
• Perio-Temp Probe (Abiodent)
• Enables the calculation of temperature
differential with a sensitivity of 0.10celcius.
• Individual temperature differences are
compared with those expected for each tooth,
and higher temperature pockets are signaled
with a red-emitting diode.
10Dr Ashish U. Bisane
11. • Haffajee et al used this probe to assess its predictability in identifying loss of
attachment, concluding that sites with a red (higher) temperature indication had
more than twice the risk for future attachment loss than did those with a green
indication.
• Haffajee et al, 1992; also found that elevated subgingival site temperature was
particularly related to attachment loss in shallow pockets and that P. intermedia, P.
micros, P. gingivalis, T. forsythia and Aac had elevated proportions in the total
microbiota in sites with elevated temperatures.
• Trikilis.N, 1999; reported differences in the temperature differentials between
subgingival temperature and sublingual temperature in smokers compared to non-
smokers.
12Dr Ashish U. Bisane
12. • The reason why temperature increases with probing
depth is unclear. A possible explanation is an increase
in cellular and molecular activity caused by increased
periodontal inflammation with increased probing depth.
• Whether the pathogens are responsible for higher
temperature by initiating the inflammatory process, or
whether the increased temperature provides an
environment favourable for the pathogens, remains
unclear.
13Dr Ashish U. Bisane
13. Periodontal Probing
• Currently the “Gold Standard” for recording changes in
periodontal status in longitudinal measurement of
clinical attachment levels.
• Factors affecting probing measurements: (Listgarten.
M. A, 1976)
1. Probing technique.
2. Probing force.
3. Size of the probe tip.
4. Angle of insertion of the probe.
5. Precision of probe calibration.
14Dr Ashish U. Bisane
14. Drawbacks in manual
probing:
1. Use of the periodontal probe - many problems in terms of sensitivity and
reproducibility of the measurements.
2. Clinical pocket depth obtained does not normally coincide with the histologic
pocket depth.
3. Inflammed tissue offers less resistance to probe penetration, and the probe tip
either coincides with or is apical to the coronal level of connective tissue
attachment. (Listgarten. M. A, 1976)
4. Healed gingiva and post subgingival instrumentation, there is increased resistance
to periodontal probing. (Magnusson. I, 1980)
15Dr Ashish U. Bisane
15. Probing Force
• Penetration of probe has been positively
correlated with probing force. (Mombelli.A,
1986)
• With forces up to 30g, the tip of probe seems
to remain within the intact junctional
epithelium (Armitage. G.C, 1994)
• Forces up to 50g are necessary to diagnose
periodontal osseous defects (Kalkwarf.K.L,
1986)
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16. Classification
• First generation probes/ conventional
• Second generation probes/pressure sensitive
• Third generation probes/ computerized
Standardization of probe tip (<1mm) and use
of registration stents have been suggested to
maintain reproducible angulations and reduce
the error. (Badersten.A. 1984)
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18. National Institute of Dental and Craniofacial Research (NIDCR) criteria
for overcoming limitations of conventional periodontal probing (Parakkal. P.F,
1979)
Limitation Conventional Probing NIDCR Criteria
1. Precision 1mm 0.1 mm
2. Range 12 mm 10 mm
3. Probing Force Non standardized Constant & Standardized
4. Applicability Non-invasive and easy to use Non-invasive , light weight
and easy to use
5. Reach Easy to access any location around all teeth Easy to access any location
around all teeth
6. Angulation Subjective A guidance system to ensure
proper angulation.
7. Security Easily sterilized.
Simple stainless steel instruments..
Complete sterilization of all
the portions entering the
mouth.
No biohazard from material or
electric shock.
8. Readout Depending upon voice dictation and
recording in writing
Direct electronic reading and
digital output. 19Dr Ashish U. Bisane
19. Florida Probe System
• Gibbs et al - developed Florida Probe System (Florida Probe
Corporation)
• Parts of Florida Probe System:
1. Probe handpiece
2. Digital readout
3. Foot switch
4. Computer interface
5. Computer
• Probe tip - 0.4 mm in diameter. This probe tip reciprocates
through a sleeve, and the edge of the sleeve provides a
reference by which measurements are made.
• These measurements are made electronically and transferred
automatically to the computer when the foot switch is pressed.
• Constant probing force is provided by coil spring inside the
probe hand – piece and digital readout.
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20. Advantages
1. Constant probing force
2. Precise electronic measurement
3. Computer storage of data
Disadvantages
1. Lack of tactile sensitivity - independent movement, which forces
the operator to predetermine an insertion point and angle.
2. Use of a fixed force setting throughout the mouth, regardless of the
site or inflammatory status, may generate inaccurate measurements
or patient discomfort.
3. One common problem reported in different studies where the
Florida Probe System has been compared with conventional
probing is the underestimation of deep probing depths by the
automated probe. (Perry. D.A. 1994)
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23. Florida Probe System to
Record CAL
• CALs are recorded relative to a fixed reference
point, such as the occlusal surfaces of the teeth
(Disk Probe) or a Prefabricated stent (Stent
Probe).
• These measurements are made sequentially
over time, and thus differences in relative
attachment levels at consecutive examinations
must be calculated.
24Dr Ashish U. Bisane
25. Florida PASHA Probe
• Modification of Florida probe to detect CEJ.
• Has a Modified Sleeve, which includes a
prominent 0.125 mm edge to facilitate a “catch”
of the CEJ.
• The width of this edge is considered small enough
not to interfere with probing depth measurement,
offering clinicians to measure CAL and probing
depth concurrently.
• Reliably reproduces and identifies CEJ in human
skulls (Preshaw.P.M, 1999) and shows promise in
measuring CALs in humans (Karpinia. K, 2004)
26Dr Ashish U. Bisane
26. Toronto Automated Probe
• The uses the occlusal-incisal surface to measure
relative clinical attachment levels.
(Mcculloch.C.A.1991)
• The sulcus is probed with a 0.5mm nickel-
titanium wire that is extended under air pressure.
• It controls angular discrepancies by means of a
mercury-tilt sensor that limits angulation within +
30 degrees, but it requires reproducible
positioning of patient’s head and cannot easily
measure 2nd and 3rd molars.
27Dr Ashish U. Bisane
27. Interprobe & Perioprobe
• An electronic probe using an optical encoder transduction element -
evaluated by Goodson and Kondon.
• These authors reported somewhat higher reproducibility with the electronic
probe compared to conventional probing and a correlation coefficient of
0.82 between the two different methods.
• This probe has now been named Interprobe (Bausch and Lomb).
• They provide constant probing force, computer storage of data, and precise
electronic management of the resulting inflammation.
• Clinical evaluations of these systems- reported slightly improved probing,
although not clinically significant
28Dr Ashish U. Bisane
28. Probes and the examination of
patients considered for implants
• Examination of patients -
considered for implants includes
both clinical evaluation of soft
tissues and a radiographic
evaluation..
• Probing around implants is difficult
(1) the prosthetic construction may
need to be removed for access
(2) standard metal instruments are
unsuitable.
• Instead, plastic or titanium probe
tips should be used to avoid
damage of the implant / tissue
interface. If automatic probing is
considered, the Florida Probe is
available with a titanium tip that
will not hurt the implant ; also, the
Interprobe system comes with
disposable plastic tips.
29Dr Ashish U. Bisane
31. Drawbacks of Conventional
Radiography
• Conventional radiographs are very specific but lack
sensitivity.
• Considerable amount of bone loss should occur for being
visible on the radiographs.
• Causes of variability in conventional radiographic
techniques:
1. Variations in projection geometry.
2. Variations in contrast and density caused by differences in
film processing, voltage and exposure time.
3. Masking of osseous changes by other anatomic structures.
32Dr Ashish U. Bisane
32. Solutions for Standardization
of Radiographic Techniques
• Radiographs should be obtained in a constant
reproducible plane using film holders with a
template containing some type of template
material, which is placed in a constant position
on a group of teeth and an extension arm that
can be precisely attached to both the film
holder and the x-ray tube (Rosling. B. 1975)
33Dr Ashish U. Bisane
33. Digital Radiography
• Digital radiography enables the use of computerized
images - stored, manipulated, and corrected for under –
and overexposures.
• Yield almost equal image properties compared with
conventional radiographs, but through digital storage and
processing, diagnostic information can be enhanced.
• Dose reduction obtained with this technique (between 1/3
to ½ of dose reduction compared with conventional
radiographs).
• Telediagnosis, video conferencing, rapid image
transmission are some of the other advantages.
34Dr Ashish U. Bisane
34. Types of Digital Intraoral Radiographic
Systems (Parks.E.T. 2002)
• First system
1. Charge – Coupled Devices (CCDs)
2. Complementary Metal Oxide Semiconductor (CMOS)
receptors as detectors.
• These devices are placed in the patient’s mouth and are
linked by a wire to the computer.
• On radiation exposure the radiographic image appears
on computer screen.
• The detector is then moved to the next position and so
on until the complete area to be imaged is covered.
35Dr Ashish U. Bisane
35. • Second System: uses Photostimulable Phosphor (PSP) plates as
detectors.
• PSP plates resemble film with one of the sides lined with a PSP
coating.
• When interacting with x-rays, PSP stores energy, which it then
releases on stimulation by light of an appropriate wavelength.
• PSP plates are placed and exposed similar to regular film.
• The exposed plates are placed on a plate scanner and scanned by a
laser beam, and the radiographic image appears on the computer
screen.
36Dr Ashish U. Bisane
36. The Digital Advantage
1. Speed of image capture and display
2. Low x-ray exposure
3. Ability to manipulate the image and maximize
diagnostic efficacy.
4. Use of digital tools such as linear, angular and
density measurements.
5. Improved patient education
6. Ease of storage, transfer and copying.
7. Seamless integration with electronic patient
record management or other software
38Dr Ashish U. Bisane
37. • Once captured and displayed, computer software can be
used to enhance the digital image and increase its diagnostic
efficacy. (Preston J D, 1999)
• Exposure can be adjusted.
• A sharpening (Edge Enhancement) filter increases the
definition and separation of adjacent structures.
• Inversion filters provide a negative of the image that might
sometime reveal diseases not seen on the positive images.
• Areas of interest can be magnified.
• Different image qualities allow better detection of dental
diseases. (High contrast for caries and Low contrast for
Alveolar Crest detection)
39Dr Ashish U. Bisane
38. Subtraction Radiography
• This technique requires a paralleling technique to obtain a
standardized geometry and accurate superimposable radiographs.
• It relies on the conversion of serial radiographs into digital images.
• The serially obtained digital images can be superimposed and the
resultant composite can be viewed on a video screen.
• Changes in the density and volume of bone can be detected as
1. Lighter areas (Bone Gain)
2. Dark Areas (Bone Loss)
• It facilitates both quantitative and qualitative visualization of even
minor density changes in bone by removing the unchanged
anatomic structures from the image.
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39. Advantages:
High correlation between alveolar bone loss
and CAL changes
Increased detection of small osseous lesion
Both quantitative and qualitative visualization
More sensitive
41Dr Ashish U. Bisane
40. • Studies using this technique have shown:
1. A higher degree of correlation between changes
in alveolar bone determined by subtraction
radiography & CAL changes in periodontal
patients after therapy. (Hausmann E, 1985)
2. Increased detectability of small osseous lesions
compared with conventional radiographs from
which the subtraction images are produced.
(Rethman M, 1985)
42Dr Ashish U. Bisane
42. • The disadvantage is the need to be almost at
identical projection alignment during the
exposure of sequential radiographs which
makes this method impractical in clinical
setting.
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43. Diagnostic/Digital
Subtraction Radiography (DSR)
• Combines the use of a positioning device during
film exposure with a specialized software
designed for digital image subtraction using
conventional personal computers in dental offices.
• The software corrects the effects of angular
alignment discrepancies and provides some
degree of flexibility in the imaging procedure.
• DSR showed statistically significant gains in
diagnostic accuracy over conventional
radiographs but no differences with Subtraction
radiography. (Nummikoski PV, 2000)
45Dr Ashish U. Bisane
44. Computer Assisted Densitometric
Image Analysis System (CADIA)
• A video camera measures the light transmitted through
the radiograph and signals from the camera are
converted into gray scale images (Bragger U, 1988)
• The camera is interfaced with an image processor and a
computer that allows the storage and mathematic
manipulation of the images.
• CADIA offers an objective method for following
alveolar bone density changes quantitatively over time.
• It has also shown higher sensitivity and a higher degree
of reproducibility and accuracy than DSR.
46Dr Ashish U. Bisane
46. • Despite difficulty in identifying all the members of the oral microbiota and
understanding how they interact with each other and with the host, a
limited number of micro-organisms have demonstrated a clear etiologic
role and have been identified as periodontal pathogens. (Genco RJ, 1996)
• Microbiologic tests to identify the putative organisms have the potential
to support the diagnosis of various forms of periodontal disease, to serve
as indicators of disease initiation and progression (i.e. disease activity)
and to determine which periodontal sites are at higher risk for active
destruction.
• Microbiologic tests can also be used to monitor periodontal therapy
directed at the suppression or eradication of periodontal pathogenic
micro-organisms.(Van Winkelhoff AJ, 1996)
48Dr Ashish U. Bisane
47. Bacterial Culturing
• Gold Standard
• Plaque samples are cultivated under anaerobic conditions using
selective and non-selective media.
• Advantage:
1. Relative and Absolute count of the cultured species.
• Disadvantage:
1. Strict sampling conditions
2. Difficulty in culturing most organisms
3. Low sensitivity : organisms lesser then 103 is difficult to detect
4. Time consuming
5. Expensive equipment and experienced personnel
49Dr Ashish U. Bisane
48. Direct Microscopy
• Dark field or phase contrast microscopy.
• Most of the periodontal pathogens are non-
motile so it is difficult to identify.
• Even different species of Treponema cannot be
distinguished by direct microscopic
techniques.
50Dr Ashish U. Bisane
49. Immunodiagnostic Methods
• Immunologic assays employ antibodies that
recognize specific bacterial antigens to detect
target micro-organisms.
1. Direct and Indirect Immunofluoroscent
(microscopic) Assays
2. Flow Cytometry
3. Enzyme Linked Immunosorbent Assay
(ELISA)
4. Latex Agglutination
51Dr Ashish U. Bisane
50. Direct Immunofluoroscent
Assay (DFA)
AB conjugated
with Fluorescein
marker
Bacteria (Antigen)
Immunofluoroscent
complex detectable
under microscope
52Dr Ashish U. Bisane
53. Flow Cytometry or
Cytofluorography
Bacterial cells + species specific antibody
+ Secondary Fluorescein Conjugated
antibody
Introduced in flowcytometer.
Bacterial cells are separated into single
cell suspension by means of laminar flow.
Cells identified by lasers.
55Dr Ashish U. Bisane
54. ELISA
• Similar to Antibody and Antigen reaction, but the
fluorescence, instead of a radioisotope, is read using an
enzymatically driven color reaction with a photometer.
• Intensity of color depends upon the concentration of the
antigen and is usually read photometrically for optimal
quantification.
Evalusite: commercially available chairside diagnostic
kit to detect Aa, Pg and Pi.
It involves linkage between antigen and a membrane
bound antibody to form an immunocomplex that is
revealed later with a colorimetric reaction.
56Dr Ashish U. Bisane
57. Latex Agglutination
• Based on binding of protein to latex.
Latex beads coated with species specific antibody
When beads come in contact with specific species in sample they bind and agglutination
occurs
Clumping of beads is visible
Test positive 59Dr Ashish U. Bisane
58. Enzymatic Methods
• Bacteria release specific enzymes.
• Certain group of species share common
enzymatic profile.
• E.g. Tf, PG, Td, and Capnocytophaga species
release trypsin-like enzyme.
• The activity of this enzyme is measured with
the hydrolysis of the colorless substrate:
N-benzoyl-d L-arginine-2-naphthylamide
(BANA)
60Dr Ashish U. Bisane
59. BANA Test
BANA Substrate
Hydrolysis by
Trypsin like
enzyme of bacteria
Hydrolysis
Formation of
Chromophore: B-
naphthylamide
Addition of Fast
Garnet
The chromophore
turns orange red
61Dr Ashish U. Bisane
60. Perioscan is a popular diagnostic kit uses
BANA reaction.
Disadvantages:
May be positive in clinically healthy site
Cannot detect disease activity
Limited organisms detected
Other pathogens may be present if it’s
negative.
62Dr Ashish U. Bisane
61. Molecular Biology for
Diagnosis
• Based on analysis of
DNA, RNA and
structure & function
of Protein of the
micro-organisms.
• A “probe” is a known
nucleic acid molecule
(DNA or RNA) from
a specific micro-
organism artificially
synthesized and
labeled for its
detection when placed
with a plaque sample.
63Dr Ashish U. Bisane
62. Nucleic Acid Probes
• A DNA probe uses a segment of a single
stranded DNA, labeled with a enzyme of a
radio isotope, that is able to hybridize to a
complimentary nuclei strand, and thus detect
presence of target microorganism.
• Two types:
1. Whole genomic probes
2. Oligonucleotide probes
64Dr Ashish U. Bisane
63. Whole Genomic Probes
• Targets the whole DNA strand rather then a
specific sequence or gene.
• High chances to cross react with non target
microorganism
• Lower sensitivity and specificity.
• Whole genomic probes for Aa, Pg, Pi and Td
have been commercially developed and tested
E.g.DMDx, Omnigene.
65Dr Ashish U. Bisane
65. Oligonucleotide Probes
• Target variable region of 16sRNA or a specific
sequence in the DNA strand.
• Higher sensitivity and specificity.
• These bacterial 16s RNA genes contain both
regions shared by different bacteria and short
stretches of variable regions shared by only
specific micro-organisms of the same species
or genus. (Moncla BJ, 1990)
67Dr Ashish U. Bisane
66. Hybridization
• Pairing of complementary strands of DNA
(nucleic acid) to produce a double stranded
DNA (nucleic acid).
• All hybridization methods use radiolabeled or
fluoroscence-labeled DNA probes that bind to
the target DNA of interest, thus allowing its
visualization.
68Dr Ashish U. Bisane
67. Checkerboard DNA-DNA
Hybridization Technology
• Developed by Socransky et.al. 1994.
• 40 bacterial species can be detected using
whole genomic digoxigenin-labeled DNA
probes.
• Large number of samples can be tested and up
to 40 oral species detected with a single test.
• Highly specific test.
• Requires expensive sophisticated laboratory
equipment.
69Dr Ashish U. Bisane
68. • Advantages of DNA probes as compared to
bacterial culturing.
1. More sensitive and specific
2. Requires as less as 104 cells of each species to
be detected.
3. Multiple species detected with a single test
4. Does not require viable bacteria
5. Large number of samples can be assessed.
• Disadvantages:
1. Expensive
2. Expert personnel to carry out the test
3. Not easily available
70Dr Ashish U. Bisane
69. Polymerase Chain Reaction
• Developed in 1985.
• Used almost universally to study DNA or RNA
obtained from a variety of tissue sources.
• Involves amplification of a region of DNA by
a primer specific to the target species.
• If there is amplification then it indicates the
presence of the target species in the sample.
71Dr Ashish U. Bisane
71. Isolation of DNA from a fresh tissue specimen.
Heating of complementary double strands of DNA.
DNA splits into single stranded forms.
Single stranded forms are intended to act as template dictating the nucleotide sequencing in vitro.
Amplification is done using a DNA polymerase that requires a primer or a known short
oligonucleotide sequence complementary to the border of the region that is to be amplified.
To obtain amplified fragments of constant length and in large quantities, a second primer,
complementary of the opposed chain must be used to bind the template and flank the region of
interest.
This amplification can be performed several number of times known as cycles.
This sequenced DNA is then detected and visualized through electrophoresis in aragose gel and
ethidium-bromure obtaining a qualitative signal.
73Dr Ashish U. Bisane
72. • In 1988, a thermo-stable DNA polymerase
isolated from the organism Thermus aquaticus
, known as Taq-polymerase was developed.
• This Taq-polymerase has allowed
automatization of the reaction using specific
appliances called thermocycles.
74Dr Ashish U. Bisane
74. Real Time PCRs
• To quantitatively assess target bacteria using
PCR technique.
• By using a single copy of the bacterial genes
per cell, a good correlation between the
fluorescent signal measured and the number of
cells can be obtained. (Lyons SR,2000; Smith
AJ, 1996)
76Dr Ashish U. Bisane
75. • Advantages:
1. High degree of sensitivity and specificity
2. Reproducible and consistent
3. High detection limit. As less as 5- 10 cells can be amplified and
detected.
4. Less cross reactivity under optimal conditions.
5. Many species can be detected simultaneously.
• Disadvantage:
1. Expensive lab equipments
2. Small quantity needed for reaction may not contain the necessary
target DNA.
3. Plaque may contain enzymes which may inhibit these reactions.
77Dr Ashish U. Bisane
76. Advances in Characterizing
Host Response
• Asses host response by studying mediators as a
response to specific bacteria or local release of
inflammatory mediators or enzymes as response to
infection.
• Source of samples may be; GCF, Saliva, or Blood.
• GCF is most commonly used, where as saliva is been
recently been researched recently.
1. Host derived enzymes
2. Inflammatory mediators and products
3. Tissue Breakdown Products
78Dr Ashish U. Bisane
77. GCF
• Most well studied, with almost 40 components in form
of host-derived enzymes, tissue breakdown products,
and inflammatory mediators.
• Collected with paper strips, micro papillary tubes,
micropipettes, microsyringes, plastic strips.
• Paper strips commonly used, introduced in sulcus for
30 secs and volume is measured using Periotron 6000.
• Periotron measures the capacitance across the wet
paper strip, which is converted to digital reading.
• Periotron reading have high correlation with clinical
gingival indices.
• Quickest and easiest way to measure GCF.
79Dr Ashish U. Bisane
79. Saliva
• The next most used after GCF.
• Easily collected
• Contains both local and systemic derived markers for periodontal diseases.
• Collected from parotid, sub-mandibular or sub lingual or as ‘Whole saliva’.
• Whole saliva contains secretions of major and minor salivary glands,
desquamated cells, and GCF.
• Markers to look for in saliva:
1. Proteins and enzymes from host,
2. Phenotypic markers,
3. Host cells,
4. Hormones,
5. Bacteria, bacterial products,
6. Volatile compounds, and ions.
81Dr Ashish U. Bisane
80. Cytokines
• Are substances released by cells of the
immune system.
• Cytokines in GCF are: TNF-alpha, IL-1, IL-6,
and IL-8
• Can be used to determine the disease activity.
• Esp. Prostaglandin E in increased in GCF of
periodontitis patients.
• Can be used to determine disease activity
82Dr Ashish U. Bisane
82. AST
• Derived from dead cells,.
• Elevated in periodontal disease
• Periogard is a commercially available colorimetric test
for AST.
• It involves GCF collection with a filter paper strip, which is
then placed in a tromethamine hydrochloride buffer. A
substrate reaction mixture containing L-aspartic and a-
ketoglutaric acids are added and allowed to react for 10min.
In presence of AST, aspartate and glutarate are catalyzed to
oxaloacetate and glutamate. Addition of a dye (Fast Red)
results in a colour product. The intensity of which is
proportional to the AST activity in GCF sample.
• However, AST levels cannot differentiate active and
inactive sites.
84Dr Ashish U. Bisane
83. • ALP: released from osteoblast, neutrophils,
fibroblast..
• Beta Glucoronidase and Elastase: found in
Neutrophils.
• Beta Glucoronidase, Elastase, Neutral protease,
and Cathepsins:
All are shown to be higher in diseased sites. May
be used to predict severity of disease or to predict
disease activity.
85Dr Ashish U. Bisane
84. Matrix metalloproteinases
• zinc and calcium dependent enzymes
• constitutively formed in the body, secreted by fibroblast
and macrophages.
• Normally help in degrading and remodeling of
extracellular matrices.
• In chronic periodontitis they cause the degradation of
the collagen fibrils in PDL and Alveolar bone.
• MMP,2,3,8 9 and 13 play important role.
• MMP8 level is associated with the attachment loss
• Level reduces in response to treatment. (Chair side test
kit)
• Can be used to indicate present disease status and
predictor of future disease.
86Dr Ashish U. Bisane
85. Tissue Breakdown Products
• Analysis of GCF obtained from sites with
periodontitis clearly show elevated levels of
hydroxyproline from collagen breakdown and
GAGs from matrix degradation. (Last KS,
1985)
• Osteocalcin and Type-I collagen peptides.
87Dr Ashish U. Bisane
86. Conclusion
• No proven marker available to predict the
disease activity as there is no proven
correlation between these markers and the
clinical loss of attachment.
• Search of tool with high predictive value,
simple, safe and cost effective still needed.
88Dr Ashish U. Bisane