Advanced diagnostic aids in periodontics /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education

www.indiandentalacademy.com

PERIODONTAL DISEASES
Estimated by signs &
symptoms of gingival
inflammation and periodontal
tissue destruction.


CLINICAL


Diagnosed by the clinical
evaluation of signs of
inflammation with or
without periodontal tissue
destruction.


PERIODONTITIS – MEASURED
BY:
A. Loss of
connective tissue
attachment.
B Loss of
radiographic
bone loss.


Provides info on the past
periodontal destruction, its
extent and severity


BUT DOES NOT PROVIDE INFO
ON :
Patient’s susceptibility
Disease progression/
remission
Positive/ negative -
response to therapy


GINGIVAL INFLAMMATION –
Redness of gingiva
Swelling
Gingival bleeding


STUDIES SAY that gingival
bleeding is a sensitive clinical
indicator of early gingival
inflammation !!


It is also a good indicator of
the presence of
inflammatory lesion in the
connective tissue at the base
of the sulcus.


SEVERITY OF THE BLEEDING
increases with an increase in
the size of inflammatory
infiltrate.


RELATION to disease progression
is unclear. healthy sites may also
evoke bleeding on probing. So
the use of gingival bleeding
cannot be totally depended upon.


INSTRUMENTS to measure
gingival temp has been
developed.
THERMAL PROBES – measure
early inflammatory changes in
the gingival tissues.
EG : PERIOTEMP PROBE


IN PERIODONTITIS, widely used
diagnostic tool is the
“periodontal probe” since increased
probing depth and loss of clinical
attachment are exclusive for this
disease.


But use of periodontal
probes presents many
problems in terms of
sensitivity and
reproducibility of
measurements.


THE DISPARITY BETWEEN
MEASUREMENTS
Depends on probing technique
probing force
size of the probe
angle of insertion
precision of probe calibration.


THE MAIN PROB IN REPRODUCIBILITY
variation in probing force.
studies show - forces upto 50g is
necessary for detecting periodontal
osseous defects!


NIDCR CRITERIA –
FLORIDA PROBE SYSTEM –
consists of a probe hand piece, digital
read out, foot switch, computer
interface and computer. tip is 0.4mm
in diameter.
Data is then transferred to the
computer .


FLORIDA PROBE


Electronic probing systems-
Interprobe system or Peri probe
system available.
Other electronic probes -Foster
miller probe, Toronto automated
probe, but not released yet.


RADIOLOGICAL


For detecting destruction of
Alveolar bone, Dental x-rays are most
commonly used since they provide
valuable info on interproximal bone
loss.


More than 30% of the bone mass
at the alveolar crest should be
lost for a change in bone height
to be seen in dental radiographs.


DIGITAL RADIOGRAPHY – by
the use of computerized
images, which can be
stored, manipulated and
corrected for under and
over exposures. advantage
- diagnostic info can be
enhanced.

SUBTRACTION
RADIOGRAPHY –
used in periodontal diagnosis.
Relies on the conversion of
serial radiographs into digital
images. then they are
superimposed to view on a
video screen.


COMPUTER – ASSISTED
DENSITOMETRIC IMAGE
ANALYSIS SYSTEM – a video
camera measures the light
transmitted through a radiograph,
signals from the camera
converted into gray scale images.
camera is fixed to an image
processor and a computer


MICROBIAL


MICROBIAL TESTS -
can also be used to monitor
periodontal therapy directed at
the suppression or eradication of
periodontopathic microorganisms


BACTERIAL CULTURING
methods are used to detect
the specific pathogens
present in plaque, by using
selective & non selective
media.


DISADV Of the above method-
strict sampling & transport
conditions essential. Putative
pathogens like Treponema
species & B. forsythes are
fastidious & difficult to
culture.


Also requires sophisticated
equipments, experienced
personnel & time consuming,
expensive !!


DARK FIELD OR PHASE CONTRAST
MICROSCOPY –
alternative method.
Directly and rapidly
assesses motility and
morphology of bacteria in
a plaque sample.
NON MOTILE ORGANISMS CANNOT BE
IDENTIFIED BY THIS METHOD.


PHASE CONTRAST
MICROSCOPE


IMMUNOLOGIC ASSAY –
employs antibodies which
recognizes specific
bacterial antigens to
detect target micro
organisms. E.g.:
Direct/Indirect IFA, ELISA,
Membrane Assay, and
Latex Agglutination.


ENZYMATIC METHODS –
B. forsythus, P.gingivalis,
Treponema denticola and
Capnocytophaga- share a common
enzymatic profile. Activity of this
enzyme can be measured by using
diagnostic kits like Perioscan.


OTHER DIAGNOSTIC ADVANCED AIDS
ARE
Nucleic acid probes,
Restriction Endonuclease
Analysis and Polymerase
Chain Reaction.


ASSESSMENT OF THE HOST
RESPONSE –
study of mediators, by
immunologic or biochemical
methods. Mediators are either
specifically identified with the
infection or represent a less
specific reaction


SAMPLE SOURCES –
Saliva, GCF, Gingival Crevicular
cells, blood serum, blood cells &
urine. Urine samples show little
promise except for its use in the
differential diagnosis of tooth loss
related to Hypophosphatasia in
young children.


MORE THAN 40 COMPONENTS OF GCF
HAS BEEN STUDIED WHICH CAN BE
DIVIDED INTO 3 GROUPS –
host derived enzymes
inflammatory mediators
tissue breakdown products


SAMPLE COLLECTION
GCF-
Method commonly used- Paper
strips.
Strips are placed in the sulcus for
a standard period of time until
the paper gets saturated


Fluid volume collected can be
quantified by using Periotron.
This device measures the change
in capacitance across the strip
and this change is converted to a
digital read out.


SALIVA – EASE OF COLLECTION….
contain both
locally and systemically derived
markers of periodontitis..
DIAGNOSTIC MARKERS in saliva
proteins & enzymes of host origin,
phenotypic markers, host cells,
hormones, bacteria & bacterial
products and ions.


Advanced diagnostic aids in periodontics /certified fixed orthodontic courses by Indian dental academy

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Advanced diagnostic aids in periodontics /certified fixed orthodontic courses by Indian dental academy