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Diagnostic Methods ForDiagnostic Methods For
Detecting PeriodontalDetecting Periodontal
DRDR.. Usama M. MadanyUsama M. Madany
A thorough questionnaire is the simplest and quickest way
to obtain vital information about medical and dental history
before examining the patient. Review with the patients
those items in his case history that require more detailed
O’Leary screening examination
The objectives of this examination are;
1-To early diagnose periodontitis.
2-To follow up previously treated patients.
A- Assessment of Gingival status
When assessing the gingival status , look for ulceration,
spontaneous hemorrhage, loss of continuity of any
interdental papillae from buccal to lingual aspects, and
marked deviation from normal contours e.g. gingival
enlargements, recession exposing root surfaces, or clefts
of gingival tissues.
B- Assessment of Periodontal status
Probe the mesiofacial line angle of each tooth and
record any depth more than 3 mm. The presence of any
hemorrhage or exudate on light probing denotes the
presence of periodontal disease. If the patient has
simple gingivitis or incipient periodontitis, detailed
periodontal examination is not indicated. This detailed
examination is indicated in cases of serious problems
3-Detailed Periodontal examination.
The diagnostic procdures are;
A- Clinical intra- and extraoral examination
B- Radiographic examination
C- Occlusal examination
D- Tests of tooth mobility
E- Evaluation of tooth vitality
F- Periodontal examination
Biopsy, if necessary
Radiographic examination and interpretation
It is essential that all radiographic studies be of diagnostic
quality (optimal exposure and processing) using paralleling
Sometimes X-ray fails to show bone defects as probing will. In
cases of interproximal two wall craters the buccal and lingual
intact bone shows clearly on X-ray. Also furcation defects may
be better determined by furcation probing
Radiographic findings of chronic periodontitis with
early or moderate attachment loss:
1-Horizontal bone loss: alveolar crest may appear to lie
greater than 2mm subjacent to CEJs, yet still parallel to
the occlusal plane.
2-Cupping defect: Interproximal crater formation. It is also
termed cup-shaped resorption.
3-Angular (vertical) bony defects: a V-shaped crevice, with
the tooth root comprising one side of the defect.
4-Furcation involvement: resorption of furcation bone
Radiographic findings in aggressive forms of
Any form of the previously mentioned defects may occur
1- Horizontal defects at or below one third of the root
2-Vertical defects my involve root apices.
3-Widening of periodontal membrane space and absence
of lamina dura
4-Severe bone loss in furcations and apical periodontitis
It is a computer assisted radiographic examination. It can
demonstrate any changes in bone density either as
disease progression or after treatment.
Check the occlusal factors that could cause damage to the
periodontium as deep overbite or overjet, wear patterns
(attrition, erosion, and abrasion), interfering occlusal
contacts. Note also the occlusal sense and tongue thrusting.
Evaluation of tooth mobility
Lindhe J, 1983
Degree 1: Movability of the crown of the tooth 0.2 to 1 mm
in a horizontal direction.
Degree 2: Movability of the crown of the tooth more than
1mm in a horizontal direction.
Degree 3: Movability of the crown of the tooth in a vertical
direction as well.
Fleszar et al., 1980
Degree 1: Slight increased mobility.
Degree 2: definite to considerable increase in mobility, but no
impairment of function.
Degree 3: Extreme mobility; a loose tooth that would be
uncomfortable in function.
Six surfaces are probed on each tooth and depth is recorded
in mm. These surfaces are; Distobuccal, buccal,
mesiobuccal, distolingual, lingual and mesiolingual.
To determine amount of probing force to be used, place end
of probe on your fingertip and press until blanching just stars
to occur. A depth more than 3 mm is considered a pocket.
Attachment level is calculated as the distance from the base
of the pocket to the CEJ. It ranges from 0-1 in normal
cases. It gives a more accurate indication of periodontal
It is performed using furcation probes. Involvement
can be classified as follows
Class I incipient bone loss
Class II partial bone loss
Class III total bone loss with through and through
Class IV as class III , but with gingival recession
exposing the furcation to view.
Classes other than I represent a doubtful prognosis
Pressure sensitive probe
Recently, pressure sensitive probes are used to
overcome the problems of pressure force. These
devices applies a force of 30 to 50 g to diagnose
pockets and osseous defects.
1- When you cannot make a clinical diagnosis.
2-To confirm your clinical diagnosis.
3- If you think that cancer is a probable diagnosis,
refer the patient to a specialist or a clinic that
normally treats cancer.
1- Detection of putative pathogens
2- Detection of host derived products as enzymes,
tissue-breakdown products, inflammatory