Perio Reports Vol. 25, No. 7 |
Perio Reports provides easy-to-read research summaries on topics of specific
interest to clinicians. Perio Reports research summaries will be included in each
issue to keep you on the cutting edge of dental hygiene science.
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Modified Manual Periodontal Probe
Many attempts at automating periodontal probing have
been made over the years, however the manual probe is still
the one used most often in practice today.
Since the manual probe is still the number-one choice of
clinicians, researchers at the Tokyo Medical and Dental
University in Japan modified a manual probe by attaching a
fiber optic sensor to record probing depths. They compared
the sensor probe to a standard manual probe for accuracy of
measurements.
The fiber optic sensor mechanism is an external sheath
that covers the manual probe, adding approximately 8mm
of length. As the probe is inserted into a sulcus, the sheath
is stopped by the gingival margin and slides back as the
probe moves forward. A spring-loaded mechanism is used as
the sheath slides back. The sliding distance is detected by the
fiber optic sensor and transmitted by cable to a personal
computer outside the mouth.
This pilot study compared probing and bleeding scores
on six individuals with moderate to severe periodontitis. Six
measurements per tooth were recorded around the first
molar in each quadrant. Measurements were repeated one
week later for comparison.
Averaging all probing scores together, the manual probe
score was 3.03mm and the fiber optic probe was 3.08mm.
In pockets 7mm or deeper, the fiber optic probe scores were
not as deep as the manual probe. This may be due to pressure
buildup on the gingival margin, pushing the margin
down, thus giving a shallower reading.
Clinical Implications: New options
might become available that modify
manual probes rather than creating automated
probes.
Ishihata, k., Wakabayashi, N., Wadachi, J., Akizuki, T., Izumi, Y.,
Takakuda, K., Igarashi Y.: Reproducibility of Probing Depth Measurement
by an Experimental Periodontal Probe Incorporating Optical Fiber. J Perio
83:(2)222-227, 2011.
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Interdental Brush Provides Patient Self-test and Plaque Removal
Gingival bleeding can be assessed between the teeth, professionally
using a periodontal probe, or by the patient using
a triangular-shaped wooden stick moved in and out from
facial to lingual four times. Self-assessment by patients of
their own gingival health provides them with feedback and a
means of cleaning between the teeth.
Researchers at the University of Zürich in Switzerland
compared periodontal probing to the use of an interdental
brush to determine if the information about bleeding, plaque
and gingivitis was similar. The test subjects were 64 consecutive
patients being seen for their semi-annual periodontal
maintenance visit with the dental hygienist. All had gingival
inflammation with at least 50 percent papillary height and
no pocket depths exceeding 4mm.
All four quadrants were tested, half with the probe
inserted 2mm into the gingival sulcus and the other half
with one pass through with an interdental brush. Rather
than using the probe on one side of the mouth and the
interdental brush on the other side of the mouth, contralateral
quadrants were assigned. Randomly assigned
quadrants were either the maxillary right and the
mandibular left or the maxillary left and the mandibular
right. The presence or absence of both plaque and bleeding
were recorded.
Average bleeding scores were similar for the sites measured
with the periodontal probe and the sites tested with the
interdental brush. Scores were 47 percent for the periodontal
probe and 46 percent for the interdental brush.
Clinical Implications: Correctly sized interdental brushes can be used as a reliable self-test for interproximal bleeding.
Hofer, D, Sahrmann, P., Attin, T., Schmidlin, P.: Comparison of Marginal Bleeding Using a Periodontal Probe or an Interdental Brush as Indicators of Gingivitis. Int J Dent Hyg 9:(3)211-215, 2010.
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Bacteria Cling to Periodontal Probes
In 1985 researchers reported the translocation of
Actinobacillus actinomycetemcomitans (Aa) from infected
sites to healthy sites. Although the bacteria were moved,
they were unable to survive the ecology of the healthy sulcular
environment. While inoculation is possible, suitable
growth conditions are required for successful colonization.
Dental hygiene researchers at
University of Missouri, Kansas City
compared four probes in sites 3mm
or less and sites 4mm or greater. A
total of eight probes were tested,
four in shallow sites and four in
deep sites. The probes were inserted
subgingivally, held there for two seconds
and removed directly to a vial
of transport medium and sealed
with wax. Each probe was then
processed for evaluation under a
scanning electron microscope.
Microbial samples from 80 pockets were collected and
cultured to compare shallow and deep pockets. As
expected, shallow pockets had fewer bacteria than deep
pockets. The researchers were surprised to see just how
rough the probe surfaces were. Striations around the metal
probes indicated use of a lathe in the manufacturing
process. Roughness and barbed edges were typical of the
cuts for millimeter markings. The plastic probes had
smoother surfaces than the metal probes and were made of
two identical halves sealed together. Excess plastic flashing
around the ball tip of these probes was evident.
All probes tested retained bacteria and epithelial cells.
No differences in bacteria retention were observed between
probe types in either shallow or deep pockets.
Clinical Implications: Despite the fact that bacteria and
epithelial cells cling to probe surfaces, clinical effects of
bacterial translocation have not been shown.
Holt, L., Williams, K., Cobb, C., Keselyak, N., Jamison, C., Brand, V.: Comparison of Probes for
Microbial Contamination Following Use in Periodontal Pockets of Various Depths. J Perio 75: 353-
359, 2004.
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The Future is Ultarsonic Probing
To diagnose periodontal disease, radiographs and
periodontal probing are always used. Radiographs
provide a two-dimensional image of three-dimensional
structures and require ionizing radiation.
Periodontal probing is an invasive procedure influenced
by clinician technique, force used, probe
size and topography of the pocket. Researchers are
looking for a non-invasive approach to diagnosis
that overcomes current sources of error.
Ultrasonography may be the answer.
Researchers in London used a non-invasive
20MHz ultrasonic imaging system to determine
bone and tissue levels from the facial surfaces of
three teeth in each of three pig jaws. A fourth pig
jaw was used for histological evaluation. A notch
was made on each tooth as a landmark. An ultrasonic
gel was used between the ultrasonic probe tip and
the gingival tissues on the facial surface of the tooth.
Measurements were taken through the gingival tissue
and provided 15mm X 6.25mm images within one second.
Images were captured in a computer and compared
to actual measurements of the pig jaws.
Trans-gingival measurements or "soundings" were done
with a periodontal probe from the gingival margin
through the attachment to the bone crest. Direct measurements
were taken after surgical reflection of the
tissue. Measurements and ultrasound images were
repeated to determine accuracy.
Differences between ultrasonic images were only
0.44mm. This was less than the 1mm error found
between sounding measurements and the 0.6mm
difference between surgical measurements. Within a
preset range of plus or minus 0.6mm there was good
agreement between ultrasound measurements and
direct surgical measurements.
Clinical Implications: The advantages of a noninvasive
ultrasound diagnostic technique will be a
welcome addition to clinical practice in the future.
Tsiolis, F., Needleman, I., Griffiths, G.: Periodontal Ultrasonography J Clin Perio 30: 849-
854, 2003.
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