pre-clinical periodontitis

Dr Jamal NaimPhD in Orthodontics

Pre-clinical PeriodonticsExamination,

Diagnosis and Prognosis

Review

Gingivitis is the inflammation of a periodontium with no

attachment loss or with previous attachment loss that

is stable and not progressing.

Periodontitis is the inflammation of a periodontium

caused by specific microorganisms resulting in

progressive destruction of the PDL and alveolar bone

(attachment loss) with pocket formation, recession or

both.

Periodontal Examination can be performed using a number of

conventional methods. However, conventional methods only give

information about past episodes of disease and their outcome.

The determination of an active site is still unattainable.

Advances into producing chair side tests, that can detect active disease or increased susceptibility to disease progression continue.

Periodontal Examination

Index

Periodontal Examination Plaque indices:

Plaque Index – PI (silness & Loe 1964) Interdental Hygiene Index - HYG Hygiene Index - HI

Gingival indices Sulcus Bleeding Index – SBI (muehlemann 1971) Gingival Index - GI Gingival Bleeding Index – GBI (Ainamo 1975) Papilla Bleeding Index – PBI (Saxer & Muehlemann

1975) Papilla Bleeding Score - PBS (Loesche 1979)

Periodontal Examination Periodontal indices

Plaque Index - PI

Interdental Hygiene Index - HYG

Interdental Hygiene Index - HYG

Interdental Hygiene Index - HYG

Disadvantages: Only one surface of the tooth is checked Not for epidemiological studies

Hygiene Index - HI

Hygiene Index - HI

Gingival indices

Sulcus Bleeding Index - SBI

Sulcus Bleeding Index - SBI

Gingival index - GI

Gingival index

Gingival Bleeding Index - GBI

Papilla Bleeding Index - PBI

Papilla Bleeding Index - PBI

Papilla Bleeding Index - PBI

Papilla Bleeding Index - PBI

Indices versus clinical findings

Indices versus clinical findings

Re

Re

Probing

with manual probe to evaluate: Pocket Depth Attachment loss

Pocket & PAL relationships

Pocket & PAL relationships

Re

Re

facial

dis

talm

esial

lingual

TM

Re

Pocket & PAL relationships

-3

Pocket & PAL relationships

0

Pocket & PAL relationships

+3

Recessions Recessions may affect the whole attached gingiva

Tooth mobility

Physiologic tooth mobility:

Initial stage (intrasocket) about 0.05 to 0.1 mm with forces of about 100g

Secondary stage (bone deform.) about 0.04 to 0.2 mm with forces of about 500g

pathologic tooth mobility:

Grade 0: normal mobility

Grade I: detectably more than normal (0.2-1mm)

Grade II: moderately more than normal, visible, > 1mm

Grade III: severe horizontal + vertical mobility

Tooth mobility

Pocket & PAL relationships

Furcations – Class I, II, III (a numerical probe can be used to assess disease progression in more detail)

Furcation involvement