PERIODONTAL PROBES

GUIDED BY:DR. RUPINDER KAUR

PRESENTED BY:DR. MALVIKA THAKUR I YEAR

CONTENTS1) Introduction2) Uses of periodontal probes3) History of periodontal probes 4) NIDCR Criteria5) Classification of periodontal probes6) Related Studies7) Non periodontal probes8) Basic concepts of probing technique9) Conclusion10) References

INTRODUCTION Probe – “to test” A calibrated probe used to measure the depth and determine

the configuration of a periodontal pocket. (Glossary of Periodontal Terms 2001- 4th edition)

1882 – John M Riggs – described probe. 1915 -1958, several studies - supported use of the periodontal

probe - to determine the disease status of gingival tissues. Periodontal probe and its use was first described by F.V.

Simoton of the University Of California, San Francisco in 1925.

Orban (1958) described the periodontal probe as “the eye of the operator beneath the gingival margin.”

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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”

Glickman stated that “The probe is an instrument with a tapered rod-like blade which has a blunt and rounded tip”

Rationale behind periodontal probing Detect and measure loss or gain of attachment level TO Determine the extent of previous or ongoing disesase activity AND Assess the effect of ongoing treatment.

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1. Assess the periodontal status for preparation of treatment plan.2. Measure - pocket depths & clinical attachment level3. Determine relationship of the gingival margin, attachment

level, and the mucogingival junction.4. Locate calculus5. Measure the width of attached gingiva. 6. Evaluate gingival bleeding on probing. 7. Locate and measure furcation involvements8. Measure the extent of apparent, visible gingival recession. 9. Determine the consistency of the gingival tissue.10.Evaluate tissue response to professional treatment post

operatively.

USES OF PERIODONTAL PROBES

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HISTORY

First described as a periodontal diagnostic instrument by John M Riggs in 1882.

The III edition of G.V. Black’s Special Dental Pathology published in 1924 mentions “the use of very thin flat explorers to determine the depth of pockets”.

Periodontal probe and its use was first described by F.V. Simoton of the University Of California, San Francisco in 1925.

The first classification of periodontal probes was given by B. L Philstrom in 1992 (I – III Generations of probes)

In 2000 Watts added IV & V Generations.

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Simonton (1925) proposed flat probes 1mm wide, 10mm long and notched every 2mm.

Box (1928) used special gold or silver probes that had 5 different angulations.

Miller (1936) suggested probing of all pockets and recording their depth and putting this information on the diagnostic chart. He used a medium thickness silver abscess probe or scalers, with a blunt blade.

The probes most commonly used today were developed by Ramfjord in 1959.

In the late 1950’s, Goldman et al, Orban et al, and Glickman published their texts on periodontal disease - agreed on the importance of the periodontal probe in diagnosis, prognosis and treatment, and supported use of the Williams probe.

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2. Color Coding. Color-coded probes are marked in bands (often black in color) with each band being several mm in width.

Characteristics of probe1. Millimeter Markingsa. The working-end of the probe is marked at

mm intervals. grooves, colored indentations, or colored bands may be used to indicate the mm markings on the working-end.

b. Each mm may be indicated on the probe or only certain mm increments may be marked

UNC 15 Probe1 ,2, 3, 4, 5,6, 7 ,8, 9 ,10, 11, 12 ,13 ,14, 15 Color coded at 5,10&15

Marquis color coded probe3, 6, 9, 12 Color coded : 3 to 6 & 9 to 12 mm

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1. Curved working end - non-calibrated furcation probe - narrow, smooth probe with round blunt end.

2. Straight working enda. Shape – slender, rod like, with a smooth rounded end; may be I .In design Tapered Straight Flat ii.In cross section Round -> Michigan, Gillmore, Merritt, Williams & Marquis Rectangular -> Goldman Fox, Drellich & Nabers

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PROBE DIAMETER

There are numerous reports using various tip diameters (0.4, 0.5, 0.6, 0.8 and 1.0 mm).

Van der Velden and Jansen (1981) suggested that with a probe 0.63mm in diameter, the optimal force to probe the most coronal connective tissue attachment was 0.75 N.

Keagle and Garnick (1989) - Probe diameter of 0.6 mm discriminated best, the different levels of gingival inflammation and health.

It is recommended that, to measure the new sulcus depth, but not to penetrate the long junctional epithelium, forces of 20 grams should be used with a probe tip diameter 0.6 mm.

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NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR) CRITERIA FOR

OVERCOMING CONVENTIONAL PROBING

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Periodontal probes are classified as:1 st generation probe2nd generation probe Pihlstrom3 rd generation probe 4 th generation probe Watts5th generation probe

Classification

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Conventional or manual probes, made up of stainless steel or plastic.

No pressure or force measuring device attached. Working end – round , tapered, flat or rectangular with smooth

rounded end. Caliberations – mm

First generation probes

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John M Riggs (1882)

G.V Black (1887) – Probe tips – flat blades : 1.5mm wide & 8mm long – slightly bent R/L.

- Also used – endodontic files – difficult acess.

HK Box (1928) – WG Cross (1966)- Set of 6 Periodontal probes – “Treatment of periodontal pocket”- 3 probe types – soft sterling silver – diff in size &form of blades.- Markings 1-16mm on one side , 2,4,6 mm – emphasized.

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Sachs (1929)- introduced periodontal probes for the first time in Europe “Paradentometer”

- Thin , 1.3mm wide V2A steel blade ( bendable)- 6 grooves at 2mm distance

Struckmann (1934)- a set of 6 probes ( stainless steel)

probe tips were 3 – 8 mm long

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CHM Williams (1936) – most popular probe

13 mm stainless steel tip•Prototype for the development of Merritt probes & University of Michigan O probe

EW Fish (1946)– probe tip – rounded & tapered - 10mm long & perpendicular to handle

Muhlemann (1960) – ZIS probe

13mm & 115ᵒ angle

Williams probe

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UNC 15- color coded probe

Marquis 1965- color coded probe.

• Calibrations are in 3mm sections.

• Markings are 3,6,9,12mm

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WHO (1978)– CPITN probe

• Prof. George S Beagre and Jukka Ainamo• Tip length- 16mm• Angle -90ᵒ.

Schmid (1967)– Plast- O - Probe

• Flexible blade shaped tip• 0.2 mm thick & 1.5 mm wide

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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

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MODIFICATIONS OF WILLIAM’S PROBE

Goldman Fox Probe• Calibrations same as Williams probe`s• flattened not round

University Of Michigan O Probe Without Williams Marking

• Markings are at 3, 6, and 8mm

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GLICKMAN PERIODONTAL PROBE• It has rounded tip with longer shank.• 1-2-3-5-7-8-9-10 mm markings.

Naber’s Probe

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Plastic Probes For Implants• Several different companies are manufacturing plastic

instruments and gold –coated curettes for use on titanium and other implant abutment metals.

• It is important that plastic rather than metal instruments be used to avoid scarring and permanent damage to the implants.

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ADVANTAGES

• 1.Easily available and inexpensive

• 2.Tactile sensation is preserved

• 3.Colour coding• 4.Can be used even in

presence of subgingival calculus

DISADVANTAGES

• 1.Probing force cannot be measured

• 2.Heavy in weight• 3.Inter-examiner

variation• 4.No computer capturing

data• 5.Assistant is required to

record thereading

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Muhleman & Son (1971) – bleeding on gentle probing

Waerhaug (1952) – light hand pressure – ≤ 0.2N/mm²

Gabathuler & Hassel (1971)– 1st pressure sensitive probe. - with the objective- quantitiating “gentle probing” - constisted of standard ZIS probe & piezoelectric pressure sensor

Hunter (1990)– TPS probe

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An electronic pressure sensitive probe– Polson et al (1980)

•Pen like handpiece & a control base•0.25 N (2.6 N/mm²)•Audio signal•Yeaple probe

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ADVANTAGES

• Constant pressure application

• Less inter examiner variation

• Comfortable to the patient

DISADVANTAGES

• Penetration into inflamed connective tissue may occur

• Assistant is required to record the readings.

• Lacks tactile sensitivity.

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These are computerized probes. The probing errors can be avoided by use of computersJeffcoat et al (1986)– Foster Miller Probe

Third generation probes

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Devised by Gibbs et al in 1988. Consists of a probe, handpiece and sleeve; a displacement

transducer; a foot switch; and a computer interface/personal computer.

The hemispheric probe tip has a diameter of 0.45 mm, and the sleeve has a diameter of 0.97 mm.

Constant probing pressure of 15 gm is provided by coil springs inside the handpiece.

FLORIDA PROBE

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Florida probe with stentLedge on acrylic stent is used as reference point

Florida probe without stentOcclusal surface or incisal edge

is used as reference point

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McCullock & Birek (1991) – Toronto Automated Probe

•Used occluso incisal surface

•Probing with 0.5 mm NiTi wire

•Advantage- incorporated electronic guidance

system

•Disadvantage- same head position required

Bose & Ott (1992) – Inter Probe (PerioProbe)

•Stainless steel probe- cause pain

•Tip – 0.5mm, probing force- 15 gm

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ADVANTAGES

• Constant pressure application.

• Errors during data recording are minimal.

• Computerized storage of data.

• Printouts can be attained.

DISADVANTAGES

• Penetration into inflamed connective tissue may occur.

• Less tactile sensitivity.

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FOURTH GENERATION Watts (2000) - 3D probes These are three dimensional probes in which sequential probe

positions are measured.

ADVANTAGES

• Allows 3D measurement of pocket.

• Sequential probe positions can be measured.

• Computerized storage of data.

• Printouts can be attained.

DISADVANTAGES

• Under development.

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Eliminates the disadvantages of earlier generation probes

The only 5th generation probe- Ultra Sonographic (US) probe

Hinders & Companion (1999)

FIFTH GENERATION

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Component of the probe - contra-angled handpiece, computer, electron box for water control, foot pedal, transducer emits and receives sound waves.

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ADVANTAGES• Non –invasive• Accurate measurement of

pocket depth• Ultra sound waves

accurately detect various periodontal structure like upper boundary of PDL and other soft tissue structures.

• Provides information regarding condition of the gingival tissues.

• Printout can be obtained

DISADVANTAGES• Technique sensitive• Expensive• Operator training

required for interpreting the image obtained.

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RELATED STUDIES Rams TE , Slots J (1993)• 3 periodontal probes - manual probe and two computerized,

pressure-sensitive probes. robing depths were determined .• Results - an electronic, pressure-sensitive probe yields more

reproducible probing depth measurements than a conventional manual periodontal probe

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L. Mayfield*,  G. Bratthall,  R. AttStröm(2005) Aim - 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 N3. The Vine Valley Probe, an electronic probe using a standardised pressure of 0.25 N4. The Peri Probe Comp, a computerised electronic probe with a controlled pressure of 0.45 N 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.

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Garnick JJ ,Silverstein L J Periodontol.2000 Aim -To determine the importance of the diameter of periodontal

probing tips in diagnosing and evaluating periodontal disease. RESULTS: The pressure used to place the probe tip at the base of the

periodontal sulcus/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.

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NON PERIODONTAL PROBES Calculus Detection Probes

1. Detect Tar Probe (Dentsply)

• Audio readings• Disadvantages

2. Perioscope-

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3. Keylaser -- InGaAs ; Er:YAG laser

Periodontal Disease Evaluation System

•Detects periodontal disease at an early stage

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Periotemp Probe (Abiodent)

•Temperature sensitive probe

•Detects early inflammatory changes in gingival tissues

Two LEDs

•Red emitting diode Green emitting diode

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BASIC CONCEPTS OF PROBING 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

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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 thelong axis of the tooth.

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INTERPROXIMAL TECHNIQUE

When two adjacent teeth are in contact, a special technique is used

to probe the area directly beneath the contact area

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PROBING DEPTH MEASUREMENTS

Six sites per tooth

One reading per site

Full millimeter measurements

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POSITIONING AND SEQUENCE FOR PROBING

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Probing is the act of walking the tip of a probe along the junctional epithelium within the sulcus .

THE WALKING STROKE

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MEASUREMENT OF CAL,RAL

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TRANSGINGIVAL PROBING

1.Gingival Recession

2.Histological Probing

3.Clinical Probing4.Bone

sounding

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PROBING HEALTHY VERSUS DISEASED TISSUE

.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 Periodontal Pocket.

In a periodontal pocket, the probe tip

touches the(JE) located on the root

below the cemento-enamel junction..

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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.The probing depth around implants presumed to be “healthy” has been about 3mm around all surfaces.

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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.

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Hefti F. Clinical Reviews in Oral Biology & Medicine 1997;8(3):336-356.

Ramachandra S. Periodontal Probing Systems: A Review of Available Equipment. Compendium 2011;32(2):2-11. Newman, Takei, Klokkevold, Carranza. Clinical

Periodontology. Tenth Edition. Gehrig J. Fundamentals of Periodontal Instrumentation. Listgarten MA, Mao R, Robinson PJ. Periodontal probing and

the relationship of the probe tip to periodontal tissues. J Periodontol. 1976;47(9):511-513

Glossary Of Periodontal Terms. 2001 4 th Edition

References

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Box HK. Treatment of the Periodontal Pocket. Toronto: The University of Toronto Press; 1928:83

Simonton FV. Examination of the mouth-with special reference to pyorrhea. J Am Dent Assoc 1925;72:287 -295.

Miller SC. Oral Diagnosis and Treatment Planning. PhiladelphiaP: . Blakiston'sS on t' Co.; 1936:239.

Orban B, Wentz FM, Everett FG, Crant DA. Periodontics, A Concept-Theorg and Practice. St. Louis: C.V. Mosby Co.; 1958:103.

Goldman HM, Schluger S, Fox L. PeriodontalTherapg. St. Louis: C.V. Mosby Co.; 1956:27.

Glickman l. Clinical PeriodontologgP. hiladelphia:W B. Saunders Co.; 1958:548.

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THANK YOU