Advances in clinical diagnosis

1. ADVANCES IN CLINICAL
DIAGNOSIS

2. CONVENTIONAL DIAGNOSIS
• Traditional clinical diagnosis
–by measuring loss of connective tissue attachment to root
surface(clinical attachment loss)
-by measuring loss of alveolar bone (radiographic bone loss)
Periodontal probe
Nabers probe
Radiographs –OPG & IOPA or BITEWING
Why do we need advanced diagnositic aids??????

3. Limitations of conventional diagnosis
• Quantifies only current clinical signs of inflammation as well as
historical evidence of damage
• Cannot identify sites with ongoing periodontal destruction
• Doesnot provide information on cause of condition, patient
susceptibility, disease progression or remission and whether response
to therapy will be positive or negative.
• No consideration is given to immunologic, systemic, genetic,
behavioural factors

4. ADVANCED PERIODONTAL DIAGNOTIC
TECHNIQUES
• Advances in CLINICAL DIAGNOSIS
• Advances in RADIOGRAPHIC ASSESSMENT
• Advances in MICROBIOLOGIC ANALYSIS
• Advances in CHARACTERISING THE HOST RESPONSE

5. ADVANCES IN CLINICAL DIAGNOSIS
• GINGIVAL BLEEDING
• Indicator of inflammation
• Objective sign of inflammation
• Severity of bleeding increases with increase in size of inflammatory
infiltrate
• Has limited predictive value for disease progression
• Its absence –high periodontal stability
• In smokers- BOP REDUCED….

6. GINGIVAL TEMPERATURE
• PerioTemp probe-thermal probes
• High temperature pockets signalled with red emitting diode
• At diseased site temperature is increased
• Why temperature increases with pocket depth is unclear
• Probability- increase in cellular and molecular activity
• Periodontal pathogens-A.A, Pgingivalis,Tforsythia increased at sites of
elevated temperature.
• In smokers- subgingival and sublingual temp show differences when
compared to non smokers…..

7. PERIODONTAL PROBING
• PERIODONTITIS-pockets and attachment loss
• Pocket probing is mandatory in diagnosing periodontitis
• Gold standard- longitudinal measurement of CAL from CEJ
• Factors on which probing depends….

8. GENERATIONS OF PROBES
• FIRST GENERATION-manual probes, conventional probes
• Eg: William’s graduated probe,CPITN probe, UNC-15 probe
• SECOND GENERATION-pressure sensitive probe
• Eg: Vine valley probe.,TPS probe
• THIRD GENERATION: automated probe
• Eg Florida probe, Toronto automated probe, Interprobe, Periprobe
• FOURTH GENERATION-Currently under development,aimed at recording
sequential probe positions along gingival sulcus
• FIFTH GENERATION-Non invasive,3-D probe:adds ultrasound or another
device to fourth generation ,aims to find attachment level without
penetrating the gingiva.
Force to probe pocket:30g
Force to probe osseous defect:50g

9. NIDCR criteria for overcoming limitations of
conventional periodontal probing
Limitation Conventional probing NIDCR criteria
Precision 1mm 0.1mm
Range 12mm 10mm
Probing force Nonstandardised Constant and standardised
Applicability Noninvasive and easy to use Noninvasive,lightweight, and easy
to use
Reach Easy to access any location around
the teeth
Easy to access any location around
the teeth
Angulation Subjective A guidance system to ensure
proper angulation
Security Easy sterilised Complete sterilisation of all
portions entering the mouth
Read out Depending on voice dictation and
recording in writing
Direct electronic reading and
digital output

10. Florida probe system
• Following NIDCR criteria florida probe system was introduced
• Consists of probe handpiece, digital readout, foot switch, computer
interface and computer.
• End of probe tip 0.4mm in diameter
• Probe tip reciprocates through a sleeve and edge of sleeve provides a
reference by which measurements are made.
• These measurements are made electronically and transferred
automatically to the computer when foot switch is pressed.
• Constant probing force is provided by coil spring
• Thus it combines advantage of constant probing force with precise
electronic measurements and computer storage of data

11. • Disadvantage
• Probing elements lack tactile sensitivity
• Uses fixed-force setting throughout the mouth regardless of whether
site is inflamed or not-inaccurate measurement or patient discomfort
• Underestimation of deep probing depths by automated probes

12. Modification of florida probe
• FLORIDA PASHA probe
• Has modified sleeve which includes a prominent 0.125mm edge to
facilitate a catch of the CEJ
This probe can reproducibly and reliably identify the CEJ in human
skulls and shows promise in measuring CALS in humans.