Article

Penetration depths with an ultrasonic mini insert compared with a conventional curette in patients with periodontitis and in periodontal maintenance

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Abstract

The aim of the study was to test whether a slim Ultrasonic Tip reaches a more apical position when penetrating a periodontal pocket compared with the working blade of a conventional Gracey Curette in both untreated periodontitis and periodontal maintenance patients. Twenty untreated and 15 periodontal maintenance patients were selected based on the presence of at least one site a pocket of > or =5 mm in each quadrant. Recordings were made at the four approximal sites of four experimental teeth in each patient. First, the probing pocket depth was measured with the Jonker Probe. Second in randomized order, the penetration depth was assessed with an EMS PS Ultrasonic Tip and a Gracey Curette. In the periodontitis group, the Ultrasonic Tip penetrated significantly deeper than the Jonker Probe and the Gracey Curette. In the maintenance group, no differences were observed. Comparing the penetration of the instruments between groups, as related to the Jonker Probe measurements, only in the periodontitis group did the Ultrasonic Tip reach a significantly more apical level. The results of the present study show that in untreated periodontitis patients, the Ultrasonic Tip penetrated the pocket deeper than the pressure-controlled probe and the Gracey Curette.

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... Mechanical therapy with hand or power-driven instrumentation (eg, ultrasonic debridement) is used to perform nonsurgical periodontal therapy. [47][48][49][50][51] Power-driven devices can be divided into sonic and ultrasonic scalers. 47 Advantages provided by power-driven instruments include less fatigue, reduced working time, and the ability to access the root furcations (approximately 1 mm wide) due to the thinness of the ultrasonic tips. ...
... 47 Advantages provided by power-driven instruments include less fatigue, reduced working time, and the ability to access the root furcations (approximately 1 mm wide) due to the thinness of the ultrasonic tips. 48,49 However, the use of these devices reduces tactile sensation. 50,51 Several recent systematic reviews reported no statistically significant differences concerning PD reduction, CAL gain, or the decrease in microbial deposits when hand and powerdriven instrumentation were compared for treatment of chronic periodontitis. ...
Article
This article summarizes the practical application of current knowledge with respect to nonsurgical treatment of periodontitis. The benefits of nonsurgical therapy with or without adjunctive therapies are discussed. The dental literature was searched for articles that addressed outcomes related to mechanical nonsurgical therapy with or without adjunctive aids to treat periodontitis. The classic periodontal literature was assessed for relevant information, and recent systematic reviews and meta-analyses of adjunctive therapies (published within the last 5 years) were evaluated. Mechanical nonsurgical periodontal therapy can provide a predictable result for the treatment of periodontitis in many situations. Unnecessary cementum removal should be avoided because it can cause root sensitivity and loss of clinical attachment in shallow probing depths. Manual and ultrasonic instruments are both effective for treating periodontitis. Depending on the clinician's preference, either manual or ultrasonic instrumentation can be used because both methods achieve equivalent results when treating most cases of periodontitis. Full- and partial-mouth scaling and root planing (SRP) are both effective therapies. At present, clinical trials have failed to show that lasers--whether used as a monotherapy or an adjunct to SRP--provide a significant clinical benefit compared with nonsurgical therapy. To date, studies have shown that the use of systemic and local drug delivery, photodynamic therapy, and probiotics as adjuncts to SRP yields modest improvements compared with SRP alone.
... Previous reviews have compared manual and sonic/ultrasonic devices for treatment of periodontal disease (Tunkel et al., 2002;Arabaci et al., 2007;Krishna and De Stefano, 2016), reporting a significant reduction in most clinical parameters with both instruments, but no statistically significant differences regarding the outcomes of periodontal clinical parameters. For deep pockets, some ultrasonic tip designs could facilitate the access to the pockets, when compared to hand curettes (Barendregt et al., 2008). However, it is important to highlight that previous training is mandatory to use these devices (Arabici et al., 2007;Krishna and De Stefano, 2016). ...
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Aims: To systemically review the literature on the effect of hand and sonic/ultrasonic instruments used for the non-surgical treatment of periodontitis. Materials and methods: Five databases were searched for randomized clinical trials that compared the results of periodontal treatment using hand and sonic/ultrasonic for nonsurgical periodontal treatment. Four meta-analyses were performed, using the calculated mean differences (MD) between baseline and 3-months or 6-months after periodontal treatment for clinical attachment level (CAL), and probing pocket depth (PPD). Results: Eighteen studies were included. All included studies showed significant improvement, in at least one periodontal parameter, in both tested periodontal therapies. The sonic/ultrasonic instruments spend significantly less time in comparison to manual instrumentation. At both 3- and 6-months after periodontal therapy, no statistically significant differences were detected for CAL gain between therapies (MD; 95%CI: 0.05; -0.21-0.30 and -0.23; -0.59-0.12). Similarly, no statistically significant differences were detected for PPD reduction between therapies at 3-months of follow-up (MD; 95%CI: -0.03; -0.34-0.28). After 6-months, the PPD reduction was 0.21 (95%CI: -0.43-0.00, p=0.05). Conclusion: Similar results may be expected for the periodontal treatment performed with hand and sonic/ultrasonic instruments. However, further studies with lower risk of bias are warranted.
... De fato, ocorre um trauma de instrumentação que varia entre 0,76 mm e 1,06 mm, em média, após raspagem dental realizada com diferentes instrumentos manuais, sem vantagem para qualquer dos instrumentos avaliados. De modo similar, o trauma de instrumentação produzido por curetas ou ultrassom não diferiu signi cativamente 40-42 .Apesar de não ter como objetivo detectar a perda de inserção imediata produzida pela raspagem, outros estudos constataram que a ponta do ultrassom penetrou mais profundamente que a cureta[43][44] .ConclusãoEm que pese o fato de o periodontista ter ao seu dispor um vasto número de instrumentos para a descontaminação do ambiente subgengival, mais importante do que o tipo de instrumento utilizado para a raspagem subgengival (manuais ou ultrassônicos), é a e cácia do procedimento destinado à remoção mecânica do bio lme presente no ambiente subgengival e, principalmente, é a conscientização do paciente com relação às medidas corretas de higiene bucal, como forma de manter a saúde dos tecidos periodontais ao longo do tempo.Merece ainda ser considerado que periodontistas mais treinados e experientes são geralmente mais capacitados ...
... Vertical lines indicate engraved markings for PCP11 (above) or PCP2 (below). deep-inflamed pockets to deeper depths ( Bulthuis et al. 1998, Barendregt et al. 2008). In this study, the tine diameter was highest for PCPUNC15 (0.57 mm)-almost equalling the suggested optimal diameter of 0.6 mm by Garnick & Silverstein (2000). ...
Article
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Thesis (M.S.)--University of Alabama (Birmingham), School of Dentistry.
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https://deepblue.lib.umich.edu/bitstream/2027.42/141307/1/jper0051.pdf
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Abstract There is presently no satisfactory method of detecting periodontal disease activity at a specified site by means of clinical measurements. This study was designed to examine the possible sources of error with regard to probing measurement reliability. Intra-examiner reproducibility of probing measurements was studied at 766 sites in 10 patients with untreated periodontitis, using a 0.25 N hinged constant force probe (a) with a stent for guidance and landmark, and (b) without stent. The stent made little difference to overall reproducibility of probing depths, though it appeared to reduce variation in different areas. Repeated probing led to an increase in some measurements, perhaps by an effect on tissues. Reproducibility of probing depth was lower in deep pockets, and about 2% of all probing depth scores varied by 3 mm or more at the same site. 4 possible sources of measurement error were noted: visual and tactile observational error, positional error and tissue change. The results are discussed in relation to the clinical detection of periodontal disease activity.
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Abstract Complete removal of calculus is a primary part of achieving a “biologically acceptable” tooth surface in the treatment of periodontitis. Rabbani et al. reported that a single episode of scaling did not completely remove subgingival calculus and that the deeper the periodontal pocket, the less complete the calculus removal. The purpose of the present study was to evaluate the effectiveness of scaling relative to calculus removal following reflection of a periodontal flap. Each of 21 patients who required multiple extractions had 2 teeth scaled, 2 teeth scaled following the reflection of a periodontal flap, and 2 teeth serve as controls. Local anesthesia was used. Following extraction, the % of subgingival tooth surfaces free of calculus was determined using the method described by Rabbani with a stereomicroscope. Results showed that while scaling only (SO) and scaling with a flap (SF) increased the % of root surface without calculus, scaling following the reflection of a flap aided calculus removal in pockets 4 mm and deeper. Comparison of SO versus SF at various pocket depths for % of tooth surfaces completely free of calculus showed 1 to 3 mm pockets to be 86% versus 86%, 4 to 6 mm pockets to be 43% versus 76% and >6 mm pockets to be 32% versus 50%. The extent of residual calculus was directly related to pocket depth, was greater following scaling only, and was greatest at the CEJ or in association with grooves, fossae or furcations. No differences were noted between anterior and posterior teeth or between different tooth surfaces.
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Previous research has shown that probing force and probe tine shape influence the clinically assessed probing depth. The purpose of the present study was to investigate the effect of tine shape and probing force on probe penetration, in relation to the microscopically assessed attachment level in untreated periodontal disease. In 22 patients, scheduled for partial or full mouth tooth extraction and no history of periodontal treatment, 135 teeth were selected. At mesial and distal sites of the teeth reference marks were cut. Three probe tines, mounted in a modified Florida Probe® handpiece, were tested: a tapered, a parallel and a bail-ended; tip-diameter 0.5 mm. The three tines were distributed at random over the sites. At each site increasing probing forces of 0.10 N, 0.15 N, 0.20 N, 0.25 N were used. After extraction, the teeth were cleaned and stained for connective tissue fiber attachment. The distance between the reference mark and the attachment level was determined using a stereomicroscope. The results showed that the parallel and ball-ended tine measured significantly beyond the microscopically assessed attachment level at all force levels; with increasing forces, the parallel tine measured 0.96 to 1.38 mm and the ball-ended tine 0.73 to 1.06 mm deeper. The tapered tine did not deviate significantly from the microscopic values at the forces of 0.15. 0.20 and 0.25 N. It can be concluded that for the optimal assessment of the attachment level in inflamed periodontal conditions, a tapered probe with a tip diameter of 0.5 mm and exerting a probing force of 0.25 N may be most suitable.
Article
Abstract The objective of this study was to evaluate the effect of the tine shape of different periodontal probes. One tapered, one parallel-sided and one WHO-probe line, each with a diameter of 0.5 mm at the tip. were mounted in hinged handles exerting a constant probing force (Brodontic®). The handles were adjusted to either 0.25 N (127 N/cm) or 0.5 N (255 N/cm). 12 patients with moderate to severe periodontitis were measured after supra- and subgmgival debridement. using all 6 possible tine force combinations in 3 sessions. In each session one tine/force combination was used in the 1 si and 3rd quadrants, and another tine/force combination in the 2nd and 4th quadrant. The measurements in the same quadrants could therefore be used for comparisons within the same site. The selection for the 2 quadrants in which a given tine/force combination was to be used, was randomised. Calculations of differences (mean per patient) between probing measurements show, that the WHO tine yields deeper recordings than the parallel sided and tapered tines, both at 127 N/cm2 and 255 N/cm2. We conclude that in addition to probing force, the tine shape of a periodontal probe is of significant importance for the recorded probing depth.
Article
The purpose of this study was to compare the tissue resistance to probing and the accuracy of depth determination at different force levels around implants and teeth. In 11 subjects 1 implant and 1 tooth at a comparable location and with comparable probing depth were investigated. The sites were located on either the mesial or distal aspect of the tooth and the implant. A probing device was used which allowed simultaneous monitoring of probing force and probe penetration and which standardized the insertion pathway for repeated measurements. The probing instrument was fitted with an attachment for an aiming device to take a radiograph with the probe tip in the sulcus, using a standardized projection geometry. Probing depth values were determined at 0.25, 0.50, 0.75, 1.00 and 1.25 N probing force. The standard error of the individual measurement (Si), evaluated by comparison of repeated measurements in the same session, was 0.2 mm on implants and 0.1 mm on teeth. For implants there was a trend for slightly better reproducibility at higher force levels. Curve analysis of depth force patterns showed that a change in probing force had more impact on the depth reading in the peri-implant than in the periodontal situation. The mean distance between the probe tip and the peri-implant bone crest amounted to 0.75 +/- 0.60 mm at 0.25 N probing force. It is concluded that peri-implant probing depth measurements are more sensitive to force variation than periodontal pocket probing.
Article
The present investigation was carried out to determine the location of the periodontal probe tip when various loads are applied. Additionally, the role of gingival inflammation to probe resistance was evaluated.The sample consisted of 51 teeth scheduled for extraction. The Gingival Index (GI) was used to establish the degree of inflammation. A loading of 20,25,30 ponds was delivered by a spring loaded sleeve bearing probe fitted with a michigan 0 probe having a terminal diameter of 0.35 mm. The extracted teeth were fixed and then stained with 4% toluidine blue. Using a coronal reference groove and the apical margin of the connective tissue attachment (CTA) as reference points apical penetrtion of the probe was established.The results of this study indicate that there is a linear relationship between the GI and the resistance of the gingival tissues to probe penetration. This is most apparent between a GI = 0 amd GI = 3. Wjereas with 30 ponds the mean penetration at GI = 0 was 0.30 mm. coronal to the CTA, the mean penetration was 1.25 mm apical to the CTA at GI = 3.
Article
The purpose of this study was to determine how accurately periodontal probes measure connective tissue attachment levels in beagle dogs with (1) clinically healthy gingivae, (2) experimental gingivitis, and (3) periodontitis. In the healthy and experimental gingivitis specimens the probes were inserted with a standardized force of 25 ponds. In periodontitis specimens the probes were inserted with a gentle, but nonstandardized force. After insertion, 120 plastic periodontal probes (40 in each group) were held in place by fusing them to the teeth. Blocks of periodontal tissue with the probes in situ were subsequently processed and serially sectioned. Histometric measurements were made from the sections in order to compare the level of connective tissue attachment to the level of probe penetration. In healthy specimens the probes consistently failed to reach the apical termination of the junctional epithelium (x = -0.39 mm). In the experimental gingivitis group most probes came closer to the apical termination of the junctional epithelium, but on the average still fell short by x = -0.10 mm. In periodontitis specimens the probes consistently went past the most apical cells of the junctional epithelium (x = +0.24 mm). A significant relationship between the degree of inflammation and level of probe penetration was found. No relationship was observed between histological and clinical sulcus depths. It is concluded that in beagle dogs (1) periodontal probes do not precisely measure connective tissue attachment levels, (2) inflammation has a significant influence on the degree of probe penetration, and (3) histological and clinical sulcus depths differ significantly.
Article
. A new periodontal probe has been developed: the pressure probe. The probe consists of a cylinder and piston assembly connected to a variable air pressure system. The working end is a metal tube in which a plunger can move freely. By means of air pressure the plunger is constantly fully extruded. During probing the plunger will intrude from the position of maximum extrusion only as the probing force exceeds the predetemined force acting on the plunger. The difference by which the plunger is intruded can be read on a millimeter scale within the handle of the probe. The purpose of the present investigation was to determine whether probing force is constant during probing, to study the reliability of reading pocket depth measurements in vitro, and to investigate the relationship between pocket depth and applied force in man. In order to evaluate whether the probing force is constant during probing, measurements were performed on a force transducer. Results show that the device makes probing possible with a constant and adjustable pressure. The influence of the reading of the calibration on pocket depth assessment in vitro was studied in an in vitro model. Results show that pocket depths of 1 mm to 8 mm ± 0.25 mm were read correctly in about 90 % of instances. Generally about 45 % of the half millimeter values were recorded as the lower whole millimeter. To investigate the relationship between pocket depth and applied force, 173 pocket depth measurements were performed in eight patients. Patients selected for this study had, in some part of the upper anterior segment, loss of alveolar bone support up to two-thirds of the root length, visible on periapical radiographs. All patients received preliminary treatment consisting of plaque control and removal of subgingival deposits. The mean Sulcus Bleeding index score was 0.2. Pocket depth measurements were carried out with forces of 0.15, 0.25, 0.50 and 0.75 N. Both approximal and vestibular pocket depths were recorded. In this study 0.75 N was chosen as the maximal force since in a pilot study a force of 1.0 N appeared too painful for patients. Results show an increasing pocket depth with increasing probing force. The mean pocket depths increased from 2.08 mm at 0.15 N to 3.71 mm at 0.75 N. Testing showed it to be statistically significant. At 0.75 N, 72 out of the 173 pockets examined were equal to or deeper than 4 mm. The percentages were calculated of differences equal to or more than 2 mm between pocket depth measurements carried out with 0.75 N and lower forces. It was found that 63.3 % of pocket depths measured with 0.15 N were, when measured with 0.75 N, 2 mm or more deeper. This was 43.1 % when 0.25 N and 0.75 N were compared and 9.7 % when 0.50 N and 0.75 N were compared. The maximal differences varied from 5 mm to 7 mm.
Article
The inaccuracy of the calibration of two Merritt-B probes, old and new style, was investigated. It appeared that the calibration of the Merritt-B "new style" probe was better than the calibration of the old one. The influence of the mode of calibration and the reading of the calibration on pocket depth assessment with a Merritt-B "old style" probe was studied in an in vitro model. The model consisted of 32 aluminium cubes each with a hole in the centre. The holes were 1 mm in cross-section and the depth varied from 0.25 mm to 8 mm in 0.25-mm increments. Results show that pocket depths of 1 mm to 8 mm +/- 0.25 mm generally were read correctly about 90% of the time. This was not true for the 4- and 6-mm areas. When a probe was used where the 4- and 6-mm marks were omitted, pocket depth in that area were read correctly only in about 60% of instances. This difference disappeared when the 4- and 6-mm marks were added. Results of measuring the half millimeter values showed that generally 80% were recorded as the lower whole millimeter.
Article
This study reported on the histometric evaluation and microscopic description of eight specimens obtained from six subjects. Blades from University of Michigan "O" periodontal probes were placed into sulci under standard pressures. With the metal probes in place, specimens were obtained in block sections, processed, stained and evaluated.
Article
A study was undertaken on 60 gingival specimens from 33 patients in order to see if a correlation exists between the Gingival Index and a newly developed histologic classification. Each specimen was scored clinically using the Gingival Index immediately prior to surgical excision. The quantitative morphologic classification with a range from 1 to 3 was based upon the number of functioning involved and uninvolved blood vessels/mm2, the number of mononuclear cells/mm2, the spread of inflammation and the number of polymorphonuclear cells/mm2. From these results of this study the following conclusions can be made: the findings of this study support the choice of these morphologic criteria because they were shown to reflect closely the criteria used for the Gingival Index. However, the most clearly identifiable criteria of the GI, the bleeding tendency, does not correlate closely with its morphologic criteria, (the number of vessels). With a more severe morphologic inflammatory involvement the plasma cells were predominantly mononuclear. Whereas the GI reflect the overall condition of gingival tissues, the morphologic classification proposed reflects more closely the state of involvement of oral and/or sulcular tissues.
Article
Recently an increasing pocket depth was found to be related to an increasing probing force. The purpose of the present study was to investigate whether or not a plateau value in pocket depth measurements exists and to study, with different probing forces, the location of the tip of the probe in relation to the periodontal fibers and the alveolar bone. Two groups of patients were selected for this study; in one group a number of teeth had to be extracted for periodontal reasons (the extraction group) and in the other a single periodontal surgical procedure was required (the surgery group). All patients received preliminary treatment consisting of plaque control and removal of subgingival deposits. At the time of the investigation the gingival condition was assessed by means of a new index, the Periodontal Pocket Bleeding Index (P.P.B.I.) The criteria were: 0 - no bleeding of the pocket after probing with a force of 0.75N, and 1 - bleeding of the pocket within 30 sec after probing with a force of 0.75N. After local anesthesia in the extraction group, reference marks parallel to the long axis of the experimental teeth were cut with a cylindrical diamond burr. By means of the pressure probe, pocket depth measurements were performed with increasing forces of 0.50, 0.75, 1.00 and 1.25N. After extraction and staining of the remnants of the periodontal fibers, the distance from the most coronal intact connective tissue fibers to the most apical point of the reference marks was measured. In the surgery group using the same pressure probe, interproximal measurements with increasing forces of 0.50, 0.75, 1.00 and 1.25N were made from the apical border of the restorations to the bottom of the pocket. The same measurement, this time to the crest of the alveolar bone, was repeated after a flap had been raised.
Article
Twenty immediate denture patients with periodontitis participated in a controlled study to determine the relationship between clinical probing of pocket depth and the connective tissue attachment. Maxillary and mandibular anterior teeth were probed clinically by one investigator to determine attachment levels. The mesial and distal facial line angles were probed from the cementoenamel junction and from a coronal bur groove, to the clinically determined attachment level. One hundred and sixteen teeth were measured. The teeth were extracted, rinsed, and stained with 4% methylene blue in 50% alcohol to demonstrate the remaining connective tissue attachment. A second investigator using the same probe as the first measured the distance from the coronal bur groove and cementoenamel junction to the most coronal extension of the connective tissue attachment. These measurements were repeated by the second investigator using a dividing caliper and a millimeter scale with a Vernier. The data were analyzed by an analysis of variance for grouped teeth, pairwise t statistic for all teeth, and an analysis of variance for all teeth. The results showed: the influence of the interaction between the patients and technique of measurement, bench and clinical, was negligible for the grouped teeth and for all teeth. The difference between the clinical and bench measurements was not significant for all the teeth as well. The null hypothesis that the difference between the clinical measurement and bench measurement is zero was satisified.
Article
In the present scanning electron microscopic study, the possibilities and limitations of non-surgical root planing were investigated. 10 single-rooted teeth from 4 patients with advanced periodontitis were studied. The root surfaces were cleaned and planed without flap reflection, using fine curettes. The teeth were then extracted and the root surfaces were systematically examined by scanning electron microscopy (SEM) for the presence of residual bacteria and calculus. 29 of 40 curetted root surfaces were free of residues, if they were reached by the curette. On the remaining 11 surfaces, only small amounts of plaque and minute islands of calculus were detected, primarily at the line angles and also in grooves and depressions in the root surfaces. Instrumentation to the base of the pocket was not achieved completely on 75% of the treated root surfaces, however. The primary reason for this was the extremely tortous pocket morphology on the teeth selected for study. In conclusion, it may be stated that during non-surgical root planing in cases of advanced periodontitis, surfaces that can be reached by curettes are usually free of plaque and calculus. However, in many cases the base of the pocket will not be reached. It is for this reason that deep periodontal pockets should be treated with direct vision, i.e., after the reflection of conservative flaps.
Article
This clinical investigation evaluated the effect on subgingival surfaces of three instruments: hand instruments and ultrasonic instruments with modified and unmodified inserts. Ten operators (five dentists and five dental hygienists) performed randomly assigned operative procedures. Pocket depth, instrument limit, and instrument efficiency were evaluated for each type of instrument. The results indicated that there are advantages to using modified ultrasonic inserts for scaling and root planing.
Article
4 probing designs have been employed to investigate the reproducibility of the Florida Probe. 3 groups (each composed of 10 subjects) were selected for the study: healthy adults, gingivitis subjects, and periodontitis subjects. The 4 probing designs were as follows: (a) the probe tip was left in the sulcus between successive probings; (b) the probe tip was removed from the gingival margin between probings but the next probing followed immediately; (c) successive whole-mouth probings were interrupted by a 5-min interval and a mouthrinse; (d) there was a 4-week interval between each probing. 3 measurements were taken for each design. The main purpose of this study was to identify variance components in the attachment level variation. The maximum probing error standard deviation was found to be around 0.3 mm, which is considerably smaller than that found in most previous studies. The errors associated with the periodontal condition and probing effect were also estimated. The variance components obtained here can be used for determining the sample size in controlled clinical studies.
Article
The aim of this study was to assess the effect of difference in tine diameter on probing pocket depth measurement. 2 sets of tines with Williams markings at 1, 2, 3, 5, 7, 8, 9 and 10 mm, and with a "round" tip, diameter 0.5 mm, were compared. One set was described as parallel-sided, the other as tapered. The parallel-sided tine was almost parallel from the 10 mm marking to the tip (tip diameter mean = 0.46 mm, 95% C.I. 0.456-0.464), while the corresponding diameter for the tapered tine varied (tip diameter mean = 0.48 mm, 95% C.I. 0.473-0.489). Calibration markings appeared highly consistent with the expected value to within 0.01 mm. The tines were mounted in Brodontic handles at 0.25 N. Examiner probing repeatability yielded kappa 0.86 for "parallel-sided" and 0.81 for "tapered" tines in vivo. 412 approximal pockets were assessed in 53 patients with routine chronic adult periodontitis, mean age 42.1 years. Each site had a probing depth of greater than or equal to 5 mm, PlI less than or equal to 1, GI less than or equal to 1, PBI less than or equal to 1. Each site was probed 2x with a 15-min interval. At the first 251 sites, the parallel-sided tine was used initially, and the tapered at the remaining 161 sites. Results indicated a highly significant tendency for the parallel-sided tine to yield a deeper reading when a difference occurred. These findings indicate that with adequate training providing high examiner repeatability, one source of error in probing data can be minimised.
Article
It was the purpose of this study to determine whether probing force had an influence on the amount of clinical attachment-gain assessed after treatment by scaling and rootplaning. A probing device was constructed which allowed simultaneous monitoring of probing force and probe penetration and which standardized the insertion pathway for repeated measurements. In 10 periodontal patients, 2 deep pockets were selected which were measured before and after periodontal treatment by scaling and root-planing. Depth-force plots were compared by superimposition. Depth values were determined at 5 different force levels (0.25, 0.50, 0.75, 1.00 and 1.25 N) on each plot and changes of clinical attachment levels were calculated. A significant relationship was seen between probing force and attachment level. The values obtained with 0.25 N were significantly different from the values obtained with higher forces (p less than 0.001). Slight, but non-significant differences were noted in the amount of attachment-gain obtained at the 5 force levels. At a probing force level of 0.25 N, there was 0.80 mm mean attachment gain. With 0.50 N, there was a gain of 0.70 mm; with 0.75 N the gain amounted to 0.67 mm in mean. At 1.00 N and at 1.25 N, a gain of 0.66 mm was recorded.
Article
The present study was designed to determine the threshold pressure value to be applied in provoking bleeding on probing (BOP) in clinically healthy gingival units. 12 female dental hygiene students volunteered for the study. They were selected on the basis of excellent oral hygiene standards, absence of probing depths greater than 3 mm and absence of caries or dental restorations on smooth and proximal tooth surfaces. Applying a probing force of 0.25, 0.5, 0.75 and 1.0 N in one of the 4 jaw quadrants, respectively, on 2 different occasions with an interval of 10 days, bleeding on probing was assessed. Oral hygiene and gingival conditions were determined using the criteria of the plaque control record and the gingival index. On the basis of the BOP values, obtained using the lowest probing force (0.25 N), the subjects were divided into 2 groups: group 1 ("minimal BOP" value) consisted of 6 subjects yielding practically no bleeding (mean BOP = 0.9%) at both examinations, while the subjects of group 2 ("low BOP" value) had slightly higher BOP% (mean BOP = 13.4%). Both groups showed significant increase in mean BOP% with increasing probing force (0.9%-36.1% in group 1 and 13.4%-47.0% in group 2). Regression analysis revealed an almost linear correlation and a high correlation coefficient between BOP% and probing force. The comparison of the regression lines of the 2 groups showed almost identical slope inclination. However, slight differences in slope inclination were found for different sites: approximal sites clearly yielded steeper regression lines than buccal/oral sites.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
This histological study correlated the depth of probe penetration to periodontal health in mongrel dogs. Various probing forces were also applied with an electronic pressure-sensitive probe and compared to manual probing. Three adult mongrel dogs with naturally occurring periodontitis in at least one quadrant were selected and gross scaling was only performed in these diseased areas. Mild gingivitis was diagnosed in other areas. One half was scaled and placed on a plaque control regimen to restore clinical health, while the other half remained untreated to maintain the existing gingivitis. The Gingival Index (GI) was recorded on 24 teeth achieving equal representation of different GI values. Probe tips were inserted utilizing manual pressure as well pressures of 15 and 25 gm directed with an electronic pressure-sensitive probe. The probes were bonded to the teeth, and the specimens were sacrificed. Blocks with the probes in place were fixed and decalcified. The probes were removed prior to processing. Sections from each probing site were microscopically analyzed, and the distance was recorded from the tip of the probe to the apical termination of the junctional epithelium (ATJE). The number of inflammatory cells was documented for two fields at x200, one coronal (X) and one apical (Y) to the penetration of the probe's tip. The data were analyzed by two-sample t-test and Pearson product-moment correlation coefficient. A strong correlation was established between probe penetration and degree of inflammation, X (r = 0.6936) and Y (r = 0.7075). The difference in mean inflammation scores between probes coronal or apical to the epithelium was highly significant (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Precise reproduction of probe placement, probing force and probing angulation may influence the reliability of replicate gingival attachment level measurements (GAL). Reproducibility of GAL measurements was determined with the Toronto automated periodontal probe (TAPP) in which a novel electronic guidance system was incorporated to improve the precision of probing angulation. Bench testing of forces produced at the probe tip was performed with an electronic balance. Reproducibility and precision of force generation were tested in a variety of instrument configurations using laboratory models. The data indicated that highly precise and reproducible probing forces can be generated with the TAPP over a large (10 to 90 g) probing range. Instrument precision was +/- 0.27 mm when probing forces of 40-60 g were used. The guidance system provided accurate and reproducible measurements of the probe handle in both roll and pitch axes when compared with precisely machined wedges (R = 0.99, roll; R = 0.98, pitch). Deviation of probing angulation greater than 5 degrees on replicate measurements of GAL was associated with significant alterations in the location of circumferential probe placement and in the size of the difference between GAL measurements (delta GAL). Clinical assessment of probing angulation in 6 patients demonstrated that delta GAL was 0.40 +/- 0.05 mm when probing angulation deviation was less than 5 degrees but increased to 0.96 +/- 0.11 mm when deviations exceeded 5 degrees. Taken together, these data indicate that the regulation of probing angulation in clinical measurement of GAL with the TAPP is an important determinant of the reproducibility of periodontal probing.
Article
A partial mouth experimental gingivitis model was employed to establish the potential efficacy of a dentifrice containing a zinc salt and the antimicrobial agent Triclosan to prevent or delay the development of gingivitis over a period of 28 days. Initially, gingival health was established in 34 subjects following a 6-week period of professional tooth cleaning and oral hygiene instruction. A toothshield was constructed to fit 4 posterior mandibular teeth. Undiluted test or placebo dentifrice was applied to the experimental teeth via the toothshield, which also prevented plaque removal from these teeth during habitual brushing of the remainder of the dentition. The presence of plaque, bleeding after probing and visual signs of inflammation were independently assessed. Plaque accumulated rapidly and gingivitis developed in both groups. At the 2-wk assessments, lower mean plaque scores were recorded for the group using the test dentifrice. At the 4-wk assessment a significantly lower level of gingivitis was recorded for the test group. It is concluded that (a) the model can be used to establish the potential efficacy of a dentifrice to maintain gingival health, (b) the dentifrice containing zinc citrate and Triclosan was efficacious and (c) the Gingival Index possibly overestimates the proportion of healthy gingival sites.
Article
Current methods of measuring periodontal probing depths at specified sites by clinical means are subject to wide variation both within and between examiners. This paper reports an investigation into the influence of a constant-force periodontal probe on intra- and inter-examiner variability when measuring probing depths. 30 sites in 10 patients with untreated chronic adult type periodontitis were examined by 2 operators, firstly using a standard periodontal pocket probe then with a constant force probe. Neither examiner was aware of the others readings and were thus blind in relation to one another. Comparison of the recordings of the 2 operators using the standard probes showed significant differences between the operators (p less than 0.01) but this difference became insignificant when the constant force probe was used. One operator had a significant variation between his standard and constant force measurements (p less than 0.01), but the other did not. Overall there was a maximum variation of +/- 1 mm in 79.9% of recordings using the standard probe and this agreement was increased to 100% with the use of the constant pressure probe.
Article
This study examined the morphology of 487 probing sites in patients with untreated periodontitis, using a constant force probe (0.25 N, 0.5 mm) and flexible stent with guide grooves, at 3 adjacent points per site, 6 sites per tooth. Sites were classified into 9 configuration types according to the relationship of the 3 adjacent points. Duplicate measurements were made and sites were analysed with special reference to whether a slight horizontal movement was likely at the second examination. 60% of individual point probing measurements were exactly reproduced, but only 23% of site configurations. 65% of configuration change was accountable on the basis of slight horizontal shift of the probe. Only 13% of configurations required the postulate of other forms of probing error. These results suggest that probing reproducibility is not always an indication of site reproducibility, and that the variation of probe position in the transverse plane is an important source of probing error, even when a stent is used.
Article
This study was undertaken to determine the effect of gingival inflammation and probing pressure on probe tip placement in relation to the base of the gingival crevice and the most coronal connective tissue attachment fibers. Nine young male beagle dogs were divided into three groups as determined by clinical status of the gingiva following implementation of a protocol designed to produce gingival health and disease. An electromechanical device was used to advance 0.6 mm diameter probes into the facial gingival crevices of selected teeth and to obtain force-displacement curves. The instrument stopped the probe at pressure of either 80, 160, 320, 640, 1280, or 2560 kPa which were randomly allocated to 12 test teeth in each dog. After the probe came to rest, it was attached to the tooth. When all 12 probes were attached, the animal was sacrificed. Blocks consisting of gingiva, probe, and tooth were processed to obtain two buccolingual sections, one containing the probe and the other immediately adjacent to it. Clinical and histometric measurements were performed and the data evaluated. Although three groups of animals were discernable by clinical criteria, only two groups, health and disease, could be formulated based on the degree of histologic inflammation. The histologic grouping was used in data analysis. Histometric distances from the cemento-enamel junction to the base of the crevice (cJ), to most coronal connective tissue attachment (cC) and to the probe tip (cP) all increased with change from health to disease. However, changes in health/disease did not influence difference between distances (cP-cJ,cP-cC).(ABSTRACT TRUNCATED AT 250 WORDS)
Article
An automated periodontal probe (APP) has been developed which measures gingival attachment level using the occlusal or incisal surface of the tooth as a fixed landmark and which transfers data directly to a computer. To assess the precision of data obtained with the new probe, duplicate measurements of gingival attachment level were made. Differences between paired data (d values) were compared with those obtained with a pressure-sensitive probe (PSP) in order to test the hypothesis that there is no significant difference in the distribution of d values between the two probes. Duplicate measurements were made 1 wk apart around 220 teeth in 19 patients using the automated probe and around 218 teeth in 24 patients with the pressure-sensitive probe. A probing force of 0.50 N was used for both probes. Greater than 83% of the d values obtained with the automated probe were less than 0.5 mm. There was no significant difference between the frequency distribution of d values for the automated probe (d = 0.28 ± 0.28 mm) and the pressure-sensitive probe (d = 0.23 ± 0.42 mm). Further, no significant differences between the two different probes were observed in maxillary, mandibular and anterior teeth. The PSP did exhibit slightly fewer d values greater than 1.0 mm for posterior teeth in comparison to the APP (0.9% for PSP, 4.4% for APP). However, d values obtained with the APP exhibited significantly less variance than the PSP for all areas of the mouth (p < 0.005). These findings support the null hypothesis that the precision of data obtained with the automated probe is not significantly different from the pressure-sensitive probe. The automated nature of the new probe and its utility in providing rapid, unbiased and precise measurements of gingival attachment level suggest that it would be very useful for the study of the natural history of periodontitis in human populations.
Article
This study investigated the immediate effects, and the effects during 12 months, of a single episode of root debridement in 1248 sites in 9 periodontitis patients. Single recordings for probing depths and probing attachment levels were made at baseline, and at 3, 6, 9 and 12 months. In addition, triplicate recordings of attachment levels were made for all sites by 3 independent examiners immediately prior to debridement, immediately post debridement, and at 3 and 12 months. It was found that a mean loss of probing attachment of 0.5 to 0.6 mm occurred as a result of instrumentation, irrespective of initial probing depth. Individual sites were identified as having lost probing attachment using a site-specific standard deviation for measurement variability and a greater than or equal to 1.0 mm change. 5% of all sites lost probing attachment from pre-instrumentation to 12 months. Approximately half of these had probing attachment loss inflicted during instrumentation. 23 sites (2% of all sites) were identified as having lost probing attachment from the post-instrumentation time point to 12 months. The majority of these sites seemed to undergo this probing attachment loss as a result of a remodelling process during the healing phase. Over the observation period used in this study, the majority of the attachment loss identified seems to be either directly attributable to instrumentation or to a remodelling process as a result of the therapy rather than to progressive periodontitis.
Article
Abstract This investigation was undertaken to study penetration-depth and simultaneous force development during the insertion of a standard periodontal probe tip into a pocket to gain information about the tissue resistance to probing and its relation to the accuracy of depth determination. A piezoelectric force transducer and a linear position transducer were incorporated into a periodontal probe. Depth-force diagrams were obtained on an x–y plotter. In 5 patients requiring treatment for chronic periodontitis, 50 sites were selected and measured 3 times before and 3 times after a treatment phase consisting of hygiene instruction, systematic deep scaling and root planing. The minimal required probing force for reproducible values within a limit of 0.5 mm up to a force of 1.2 N was determined for each record (“b-value”) and correlated in a multiple linear regression analysis with a number of clinical parameters of the sites. Depth-force diagrams recorded with the probe showed the characteristics of saturation curves flattening off in the range of 1 N and more. When the probing force was increased from 0.41 N up to 1.2 N, 50% of all measurements showed an increase in depth of more than 0.5 mm. However, increasing from 0.9 to 1.2 N resulted in a change of more than 0.5 mm in only 5% of the measurements. Differences in b-values before and after the treatment were significant (p < 0.01). Differences related to tooth type (M, PM, I) and conventional pocket depth before treatment were also significant (p < 0.05). In general, minimal probing force had to be 0.075 N higher after the treatment and 0.101 N higher in pockets originally deeper than 5 mm to maintain the same depth reading up to a force of 1.2 N. It was concluded that the influence of probing force on the reproducibility of probing depth was more important after treatment by oral hygiene, deep scaling and root planing.
Article
A new automated periodontal probe has been developed which measures attachment level relative to the cemento-enamel junction in a single measurement. The probe tip automatically enters the periodontal pocket and retracts under controlled force. As the probe tip transverses the cemento-enamel junction, the electronics detect an alteration in the acceleration of the probe tip. Thus, the location of the cemento-enamel junction is determined automatically. The repeatability and accuracy of the probe was assessed in vitro. Measurements of attachment level were repeatable to 0.03 mm, and the probe had a net accuracy of 0.04 mm.
Article
Elimination of gingival bleeding has been related to a reduction in inflammation; however, histologic data are not available to support this association. The purpose of this study was to characterize the histology of interproximal gingiva that was converted from a bleeding to a nonbleeding state. An interproximal gingival biopsy was obtained from each of 32 patients, 15 of whom bled upon stimulation with a soft wooden interdental cleaner. The remaining 17 biopsies were obtained from sites which initially bled, but were converted to nonbleeding by scaling and interproximal plaque control. Specimens were processed for light microscopic evaluation and subjected to a morphometric analysis for various tissue components. Data from bleeding and "stopped bleeding" specimens were compared using analysis of covariance. The results indicated that "stopped bleeding" specimens had significantly less inflamed connective tissue. It was concluded that the conversion of a bleeding to a nonbleeding state corresponds with a histological reduction in the magnitude of the interproximal inflammatory lesion and provides a rationale, therefore, for the use of bleeding to monitor the effects of therapeutic methods.
Article
10 adult patients with periodontitis were treated with oral hygiene instruction and a single episode of supra- and subgingival debridement using either a sonic or an ultrasonic instrument in a split-mouth design. The clinical response was evaluated by measurements of dental plaque, bleeding on probing, probing depths, and probing attachment levels taken at baseline and every 3rd month for 12 months. An improvement of periodontal conditions was observed during the initial 3-6 month period followed by a stabilization of parameters. No difference in clinical response could be observed between sites treated with the sonic or ultrasonic instruments.
Article
The present study compared surgical therapy to root planing alone in the treatment of periodontal intraosseous defects. 25 defects in 14 patients were subjected to root planing only and another 25 defects in the same patients were surgically exposed and citric acid treated. The healing response was evaluated 6 months after treatment. The mean gain of probing attachment level was 0.8 mm in the root-planed defects as compared to 1.3 mm for the surgically exposed and acid-treated defects. The probing bone level improved an average of 0.2 mm for the root-planed areas as compared to 0.6 mm for the acid-treated defects. The mean preoperative probing pocket depths of 6.7 mm and 6.8 mm for the 2 groups were reduced to 5.2 mm and 4.1 mm, respectively. The differences in these parameters were statistically significant between the 2 groups. However, both groups demonstrated limited regeneration.