seminar PDL...free to ask questions

1. PERIODONTAL PROBING AND
TECHNIQUES
By
Dr Johnn Kazimm
DEPARTMENT OF PERIODONTICS
AT
I.T.S DENTAL COLLEGE, HOSPITAL & RESEARCH
CENTRE, GREATER NOIDA

2. INDEX
• Introduction
• History
• Standard Periodontal Probe
• Classification
• Types of Periodontal Probe
• Probing technique
• Pressure Sensitive Probe
• Principles
• NIDCR Criteria
• Florida Probing System
• Per implant Probing
• Conclusion
• References

3. DEFINITION
• PERIODONTAL PROBE
• A calibrated probe used to measure the depth and
determine the configuration of a periodontal
pocket.(1)

4. • The Latin word probo means “to test.”
• 1882 – John W Riggs – described probe.
• Between 1915 and 1958, several studies supported use of the periodontal probe to determine
the disease status of gingival tissues.(2)
• Periodontal probe and its use was first described by F.V. Simoton of the University Of
California, San Francisco in 1925. (3)

5. • Miller suggested probing of all pockets and recording their depth and
putting this information on diagnostic chart.(4)
• Simonton proposed flat probes 1 mm wide, 10 mm long, and notched
every 2 mm. Box used special gold or silver probes that had different
angulations.
• Orban (1958) described the periodontal probe as “the eye of the
operator beneath the gingival margin.(5)

6. Goldman & Glickman
• Goldman et al . stated that "Clinical probing with suitable periodontal
instruments such as the Williams calibrated probe is a prime necessity in
delineating the depth, topography and character of the periodontal Pocket “
.(6)
• Glickman I stated that "The probe is an instrument with a tapered rod-like
blade which has a blunt and rounded tip.“(7)

7. • The probes most commonly used today were developed by Ramfjord in 1959.
“ the probes in use at that time were too thick to probe narrow clinical pockets and designed a
round probe with a tip diameter of 0.4 mm “(8)
• In 1967, Clavind and Loe reported the results of a research protocol in which
they used a periodontal probe tip that was 0.8 mm in diameter with a 10 gram
force.(9)

8. • In 1992, B. L. Pihlstrom created a classification of periodontal probes. (10)
• The classification system included three generations of probes: first, second
and third generations.
• In 2000, Watts extended the classification system to include a fourth and fifth
generation of probes.(11)

9. FIRST GENERATION
• First-generation probes -> manual, handheld instruments, also called
conventional probes.
• In 1936, Charles H. M. Williams -> The Williams’ probe,13 millimeters in
length and one millimeter in diameter, with demarcation lines at 1, 2, 3, 5, 7,
8, 9 and 10 millimeters.(12)

10. University Of North Carolina-15
• UNC-15 :
• 15-mm-long probe with
markings at each millimeter
• Colour Coding at the 5th,10th
and 15thmm.
Carranza's Clinical
Periodontology e-dition, 10th Edition
By Michael G. Newman, DDS, Henry
Takei, DDS, Perry R. Klokkevold, DDS,
MS and Fermin A. Carranza, Dr. Odont

11. MICHIGAN “O” PROBE
.
Carranza's Clinical
Periodontology e-dition, 10th Edition
By Michael G. Newman, DDS, Henry Takei,
DDS, Perry R. Klokkevold, DDS, MS and
Fermin A. Carranza, Dr. Odont
Markings are at 3, 6, and 8mm

12. NABER’S PROBE
• Determine the extent of furcation involvement on a multi rooted teeth.
• Curved working end for accessing the furcation area.
• The depth of insertion of the probe into the furcation area determines the degree of furcation
involvement.
Carranza's Clinical
Periodontology e-dition, 10th Edition
By Michael G. Newman, DDS, Henry Takei,
DDS, Perry R. Klokkevold, DDS, MS and
Fermin A. Carranza, Dr. Odont

13. GOLDMAN-FOX PROBE
Rectangular in cross section and has
millimeter markings(mm)
markings at 1-2-3-5-7-8-9-10. Fundamentals of
Periodontal
Instrumentation &
Advanced Root
Instrumentation

14. WHO PROBE
• In 1978.
• The probe was designed for two purposes:
-Measurement of pocket depth.
-Detection of sub gingival calculus.
• Used in the assessment of CPITN (Community Periodontal Index for Treatment Needs)
• Weight = 5 gm

15. CPITN-E Probe (Epidemological Probe)
Markings at 3.5 and 5.5mm.
 CPITN-C Probe(Clinical Probe)
Markings at 3.5, 5.5, 8.5 and 11.5mm.
Ball Tip -> 0.5 mm

16. SECOND GENERATION PROBES
• Constant Pressure probes designed to provide for standardization of controlled
probing pressure.
• Frank Hunter in 1994
• The TPS (True Pressure Sensitive) probe
• 20 grams of force
• Resistance and the indicator lines coincide, a constant pressure of
20 grams has been reached, and the reading is then taken. (13)

17. TRUE PRESSURE SENSITIVE PROBE
Periodontal ProSrinivas Sulugodu
Ramachandra,
Periodontal Probing Systems: A
Review of Available
Equipment.Dental ageis
March 2011;32,(2) I

18. THIRD GENERATION PROBE
• Third-generation probes refer to automated probing systems.
• Software integrates with existing computer systems to provide
computerized periodontal charting.
• The Florida Probe, first available in 1987, devised by Gibbs..is one such
automated probing system that efficiently allows for hands free charting
and generates a detailed, computerized periodontal chart.
• The Florida Probe has a constant pressure of 15 grams and a precision of
0.2 millimeters
• Toronto Automated Probes

19. THE FLORIDA PROBE
• Gibbs 1988
• Probe hand piece and sleeve;
• Displacement transducer
• Foot switch
• Computer interface/personal computer. Probe tip has a diameter of 0.45 mm,
• Sleeve has a diameter of 0.97 mm . Constant probing pressure of 15 gm is provided
by coil springs inside the handpiece.(14)
Periodontal ProSrinivas Sulugodu
Ramachandra,
Periodontal Probing Systems: A
Review of Available
Equipment.Dental ageis

20. INTER PROBE
.
Available At
Interprobe.com
A flexible probe tip, which curves
with the tooth as the probes enter
the pocket area.
Stainless steel probes push the
gingiva away from the tooth,
causing pain, whereas the
InterProbe gently slides

21. FOURTH GENERATION PROBES
• Refer specifically to 3D technology,
• With the goal of obtaining a precise and continuous reading of
the base of the sulcus or pocket.

22. FIFTH-GENERATION PROBES
• Designed to utilize ultrasound, in addition to 3D.
• Aim to accurately measure attachment levels without penetrating the Junctional epithelium
• For a more comfortable examination and a precise mapping

23. The US probe
• Was devised by Hinders and companion at the NASA Langley Research Center.
• Small intraoral ultrasound beam projection area gives the Image of the periodontal
ligament space.
• To probe these structures ultrasonically, a narrow beam of ultrasonic energy is
projected
Avaliable At
www.USPROBE.COM

24. The Diamond Probe
• Detects periodontal disease during routine dental examinations by measuring
relative sulfide concentrations as an indicator of gram-negative bacterial
activity.
Single-use disposable probe tip with microsensors connected to a main
control unit.(15)
• The probe might detect periodontal disease at an early stage and might find
an active site that requires treatment. However, the probing pressure is not
controlled.

25. DIAMOND PROBE
Avaliable At
www.devicelink.com/expo
/old_awards/dntlnstrmnts
eq.html

26. PERIO – TEMP PROBE
• The Periotemp® Probe (Abiodent Inc, Danvers, MA) temperature-sensitive probe,
• detects early inflammatory changes in the gingival tissues by measuring temperature variations in these
tissues.(16)
• Detects pocket temperature differences of 0.1oC from a referenced subgingival temperature.
• This probe has two light indicating diodes: red-emitting diode, which indicates higher temperature,
denoting risk is twice as likely for future attachment loss; and green-emitting diode, which indicates a
lower temperature, indicating lower risk.
• This probe can detect initial inflammatory changes; therefore, treatment can be initiated at an early stage

27. Detec TAR
• DetecTar’s fiber-optic probe reads light reflected off tooth structure and transmits it to an
internal computer for analysis.
• DetecTar sounds a tone when it detects the unique spectral signature of subgingival calculus
The probe tip emits light from a light-emitting-diode
(LED). Reflected light -> analyzed by a
microprocessor-supported-algorithm to determine the
presence of calculus. When calculus is detected the
system lights up and an audible “beep” occurs

28. Avaliable at
www.dentistryindia.n
et/content/DI/img/200
9/05(17)

29. RELATED STUDIES
• Rams TE , Slots J (1993) (18)
• Three periodontal probes--a manual probe and two computerized, pressure-sensitive probes--were
studied to determine their relative recording accuracy. Probing measurements were taken with the three
probes at shallow (less than 5 mm) and deeper (greater than or equal to 5 mm) periodontal sites.
• Probing depths were determined on all teeth except third molars by the three probing techniques at a
single appointment. All three probes demonstrated higher standard deviations with increasing depth,
which indicates decreased reproducibility of probing depth measurements.
• Results ->
• an electronic, pressure-sensitive probe yields more reproducible probing depth measurements than a
conventional manual periodontal probe

30. RELATED STUDIES
• L. Mayfield*, G. Bratthall, R. AttStröm(2005)(19)
• The aim of this study was to compare the relative intra- and inter-examiner reproducibility of 4
different periodontal probes. :
• 1.The Hu-Friedy LL 20 Probe, a manual probe.
• 2.The Vivacare TPS Probe, a plastic manual probe with a standardised pressure of 0.20
3.The Vine Valley Probe, an electronic probe using a standardised pressure of 0.25 N
• 4.The Peri Probe Comp, a computerised electronic probe with a controlled pressure of 0.45 N
• Duplicate probing measurements were taken by 2 examiners in 10 patients on 3 Teeth ,were
selected to incorporate both (<5 mm) (>5 mm) periodontal sites. The order of probes and
examiners were changed in a systematic manner and measurements were repeated 1 week later to
avoid bias due to examiner memory.
• Results show that the manual probe had the lowest degree of variation, with a correlation
coefficient of 0.83.
• The manual and Peri Probe Comp frequently recorded deeper probing pocket depths compared to
the TPS and Vine Valley probes.

31. RELATED STUDIES
• Garnick JJ ,Silverstein L(20) J Periodontol.2000
• The purpose of this study was to determine the importance of the diameter of periodontal probing tips in diagnosing and
evaluating periodontal disease.
• Probe advancement between the gingiva and the tooth is determined by the pressure exerted on the gingival tissues and
resistance from the healthy or inflamed tissue. The pressure is directly proportionate to the force on the probe and inversely
proportionate to the probe tip diameter
• RESULTS:
• In the studies reviewed, the pressure used to place the probe tip at the base of the periodontalsulcus/pocket was
approximately 50 N/cm2 and at the base of the junctional epithelium, 200 N/cm2. A tip diameter of 0.6 mm was needed to
reach the base of the pocket. Clinical inflammation did not necessarily reflect the severity of histological inflammation.
• Probe tips need to have a diameter of 0.6 mm and a 0.20 gram force (50 N/cm2) to obtain a pressure which
demonstrates approximate probing depth. This pressure was needed to measure the reduction of clinical probing
depth, which included formation of a long junctional epithelium as a result of therapy.

32. Factors Affecting Probing
• Design of the probe,
• Probing force,
• Probe position,
• Probing direction
• Pocket depth,
• Tissue inflammation.(21)

33. Design
• MILLIMETER MARKINGS ->
• 1. Millimeter Markings
a. The working-end of the probe is marked at millimeter intervals.
• grooves, colored indentations, or colored bands may be used to indicate the millimeter markings on the
working-end.
• b. Each millimeter may be indicated on the probe or only certain millimeter increments may be marked
• 2. Color Coding. Color-coded probes are marked in bands (often black in color)

34. FUNCTION
.
• Function ->
Determine the health of the periodontal tissues
To measure pocket depths,
To measure clinical attachment levels,
To determine the width of attached gingiva, to assess for the presence of bleeding and/or purulent
exudate (pus),and to measure the size of oral lesions.

35. Working End
Working‐End
• Blunt
• Rod‐shaped
Cross‐section
• Round
• Rectangular
Types
• Calibrated
• Non Calibrated Avaliable At Wikipedia.org/
periodotal probe.

36. PRINCIPLES
• ADAPTATION
• The side of the probe tip should be kept in contact with the tooth surface. The probe tip is defined
• as 1 to 2 mm of the side of the probe.
Correct In correct

37. PARALLELISM
The probe is positioned as parallel as possible to the tooth surface.
• The probe must be parallel in the mesiodistal dimension and faciolingual dimension.
Probe Parallel to Long Axis.
Probe is correctly positioned parallel to the long axis of the tooth.
Probe Not Parallel to Long
Axis.
Probe is incorrectly
positioned in relation to the
long axis of the tooth.

38. TECHNIQUE
• Probing is the act of walking the tip of a probe along the junctional epithelium within
the sulcus .
• THE WALKING STROKE
• The walking stroke is the movement of a calibrated probe around the perimeter of the base of a
sulcus or pocket.( 22)
• Walking strokes are used to cover the entire circumference of the sulcus or pocket base.
• It is essential to evaluate the entire “length” of the pocket base because the junctional epithelium is not
necessarily at a uniform level around the tooth.

39. PRODUCTION OF THE WALKING STROKE
1. Walking strokes are a series of bobbing strokes that are made within the sulcus or
pocket. The stroke begins when the probe is inserted into the sulcus while keeping the probe
tip against the tooth surface.
2. The probe is inserted until the tip encounters the resistance of the junctional epithelium
that forms the base of the sulcus.
3. Create the walking stroke by moving the probe up and down in short bobbing strokes and
forward in 1-mm increments .With each down stroke, the probe returns to touch the
junctional epithelium.
4. The probe is not removed from the sulcus with each upward stroke.
5. The pressure exerted with the probe tip against the junctional epithelium should be
between 10 and 20 grams.

40. WALKING THE PROBE
Fundamentals of
Periodontal
Instrumentation &
Advanced Root
Instrumentation
By Jill S. Nield-Gehrig
Gingival
margin
Probing
depth

41. PROBING (ANTERIOR TOOTH)
• 1.Begin on the distofacial or distolingual line
• 2.Begin by inserting the probe at the distofacial line angle
• 3. Walk toward the distal surface.
• 4. Assess beneath the contact area. Tilt the probe and
extend the tip beneath the contact area.
• Press down gently to touch the junctional epithelium
• 5. Assess the facial surface. Make a series of walking
strokes across the facial surface.
• 6. Walk toward the mesial surface. Walk across the
mesial surface until the probe touches the contact area.
• 7. Assess beneath the contact area. On adjacent anterior
teeth, only a slight tilt is needed to probe the col area.
• Gently probe the col area..

42. Probing(Posterior Tooth)
• 1. Assess beneath the contact area. Tilt the probe so that the tip
reaches beneath the contact area (the upper portion of the probe
touches the contact area).
• Gently press downward to touch the junctional epithelium.
• 2. Reinsert at the distofacial line angle.
Remove the probe from the sulcus and reinsert it at the
distofacial line angle.
• 3. Probe Site Make a series of tiny walking strokes across in a
forward direction toward the mesial surface.
• 4. Walk the probe across the mesial surface until it touches the
contact area.
• 5. Assess beneath the contact area. Tilt the probe and extend
the tip beneath the contact area.
• 6. Press down gently to touch the junctional epithelium.

43. Jerry J. Garnick and Lee
Silverstein.Periodontal
Probing.J Periodontal
;7(1) 2000 96-103

44. Measurement Of CAL,RAL

45. TRANSGINGIVAL PROBING
1.Gingival Recession
2.Histological
Probing
3.Clinical Probing
4.Bone sounding

46. PROBING HEALTHY VERSUS DISEASED TISSUE
• 1. Clinically Normal Sulcus
• a. In health, the tooth is surrounded by a sulcus. The junctional epithelium (JE) forms the base
of the sulcus by attaching to the enamel of the crown near the cemento-enamel junction (CEJ).
• b. The depth of a clinically normal gingival sulcus is from 1 to 3 mm, as measured by a
periodontal probe.
• 2. Periodontal Pocket
• a. A periodontal pocket is a gingival sulcus that has been deepened by disease.
• In a periodontal pocket, the JE forms the base of the pocket by attaching to the root surface
somewhere apical to the CEJ.
• A periodontal pocket results from destruction of alveolar bone and the periodontal ligament
fibers that surround the tooth.(22)

47. PROBING
.
Position of Probe in a Healthy
Sulcus. In health,
the probe tip touches the junctional
epithelium
located above the cemento-enamel
junction.
Position of Probe in a
PeriodontalPocket. In a
periodontal pocket, the probe tip
touches the(JE) located on the root
below the cemento-enamel junction..

48. NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH
(NIDCR) CRITERIA FOR OVERCOMING CONVENTIONAL PROBING(23)

49. PERI IMPLANT PROBING
• The results obtained with peri implant probing cannot be interpreted same as the natural teeth
because:
- Differences in the surrounding tissues that support implanted teeth.
- Probe inserts and penetrates differently.
- Around natural teeth, the periodontal probe is resisted by the insertion of supra-crestal
connective tissue fibers into the cementum of root surface. There is no equivalent fiber
attachment around implants.(24)

50. PERI IMPLANT PROBING
Advantages:
- Can measure the level of mucosal margin relative to a fixed position on the implant.
- Measure the depth of tissue around the implant.
-Periimplant probing depth is often a measure of the thickness of surrounding connective
tissue and correlates most consistently with the with the level of surrounding bone.
• The probing depth around implants presumed to be “healthy” has been about 3mm around all
surfaces.

51. CONCLUSION
• Newer developments in the field of periodontal probes provide
the potential for error-free determination of pocket depth.
• With more research and innovation, the advent of newer error-
free probes may resolve the remaining problems and those yet
to be realized.

52. Thank you

53. REFERENCE
• 1.Glossary Of Periodontal Terms. 2001 4 th Edition
• 2. Box HK. Treatment of the Periodontal Pocket. Toronto: The
University of Toronto Press; 1928:83
• 3. Simonton FV. Examination of the mouth-with special reference to
pyorrhea. J Am Dent Assoc 1925;72:287 -295.
• 4. Miller SC. Oral Diagnosis and Treatment Planning.
PhiladelphiaP: . Blakiston'sS on t' Co.; 1936:239.
• 5. Orban B, Wentz FM, Everett FG, Crant DA. Periodontics, A
Concept-Theorg and Practice. St. Louis: C.V. Mosby Co.; 1958:103.

54. REFERENCE
• 6. Goldman HM, Schluger S, Fox L. PeriodontalTherapg.
St. Louis: C.V. Mosby Co.; 1956:27.
• 7. Glickman l. Clinical PeriodontologgP. hiladelphia:W B.
Saunders Co.; 1958:548.
• 8. Ramfjord SP. Indices for prevalence and incidence of
periodontal disease. J Periodontol 1 959;30:5 1 -59.
• 9. Glavind L, Loe H. Errors in the clinical assessment of
periodontald estruction.J PeriodontR es'1967; 2:780-784.

55. REFERENCE
• 10. Pihlstrom BL. Measurement of attachment level in clinical
trials: Probing methods. J Periodontol. 1992;63(12
Suppl):1072-1077
• 11. Watts TLP. Assessing periodontal health and disease. In:
Periodontics in Practice: Science with Humanity. New York,
NY: Informa Healthcare; 2000:33-40.
• 12. Williams CHM. Some newer periodontal findings of
practical importance to the general practitioner. J Can Dent
Assoc. 1936;2:333-340
• 13. Birek P, McCulloch CAG, Hardy V. Gingival attachment
level measurements with an automated periodontal probe. J
Clin Periodontol. 1987;14(8):472-477.

56. REFERENCE
• 14. Gibbs CH, Hirschfeld IW, Lee JG, et al. Description and
clinical evaluation of a new computerized periodontal
probe-the Florida Probe. J Clin Periodontol.
1988;15(2):137-144.
• 15. Zhou H, McCombs GB, Darby ML, et al. Sulphur by-
product: the relationship between volatile sulphur
compounds and dental plaque-induced gingivitis. J
Contemp Dent Pract. 2004;5(2):27-39
• 16. Kung RT, Ochs B, Goodson JM. Temperature as a
periodontal diagnostic. J Clin Periodontol. 1990;17(8):557-
563
• 17. http://www.dentistryindia.net/content/DI/img/2009/05

57. REFERENCE
• 18. Rams TE, Slots J Comparison of two pressure-sensitive
periodontal probes and a manual periodontal probe in shallow
and deep pockets.Int J Periodontics Restorative Dent. 1993
Dec;13(6):520-9.
• 19. L. Mayfield*, G. Bratthall, R. AttStröm Periodontal probe
precision using 4 different periodontal probes Journal of
Clinical Periodontology23;(20)76–82, February 1996
• 20. Garnick JJ, Silverstein L Periodontal probing: probe tip
diameter.J Periodontol. 2000 Jan;71(1):96-103.
• 21. Crit Rev Oral Biol Med. Periodontal probing.
1997;8(3):336-56. Hefti AF.

58. REFERENCE
• 22. Fundamentals of Periodontal Instrumentation & Advanced
Root Instrumentation Jill S. Nield-Gehrig.pg 226-227
• 23. Parakkal PF. Proceedings of the workshop on quantitative
evaluation of periodontal diseases by physical measurement
techniques. J Dent Res. 1979;58(2):547-553
• 24.Armitage GC,Svanber G K,Loe H,Microscopic evaluation
of clinical measurements of connective tissue attachment
levels J clin Periodontal 1977;4 173-190.