Diagnostic Methods For Diagnostic Methods For Detecting Periodontal Detecting Periodontal

DiseasesDiseasesDRDR. . 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

information.

1-Thorough questionnaire

2- Cursory ExaminationO’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 examinationB- Radiographic examinationC- Occlusal examinationD- Tests of tooth mobilityE- Evaluation of tooth vitalityF- Periodontal examinationBiopsy, if necessarySupplemental diagnostics

Radiographic examination and interpretation

It is essential that all radiographic studies be of diagnostic quality (optimal exposure and processing) using paralleling technique.

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 periodontitis

Any form of the previously mentioned defects may occur adding to

1- Horizontal defects at or below one third of the root length.

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

Digital subtraction It is a computer assisted radiographic examination. It can

demonstrate any changes in bone density either as disease progression or after treatment.

Occlusal examination

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.

Periodontal Examination

Pocket Probing :. 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 disease progression

Attachment Level

Furcation Probing 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

bone defect. 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.

Biopsy

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.

Supplemental diagnostics

1- Detection of putative pathogens

2- Detection of host derived products as enzymes, tissue-breakdown products, inflammatory mediators.

Thank you