Periodontal Assessments Part 2 PDF

Periodontal Assessments Part 2 Founda2ons in Clinical Skills and Prac2ce Pat Lazarou Intended Learning Outcomes By the end of this session students should be able to: De3ne the term furca7on involvement Revise morphology of mul7 rooted teeth Iden7fy the Nabers probe and describe it’s ke...

Periodontal Assessments Part 2 Founda2ons in Clinical Skills and Prac2ce Pat Lazarou Intended Learning Outcomes By the end of this session students should be able to: De3ne the term furca7on involvement Revise morphology of mul7 rooted teeth Iden7fy the Nabers probe and describe it’s key features Describe the grades of furca7ons (Glickman 1953) Iden7fy the challenges associated with undertaking a furca7on index Describe the mobility index (Miller 1950) Furca2on Index Glickman (1953)  * Furca2on Involvement 2 roots - bifurcation 3 roots - trifurcation Progression of periodon77s around mul7-rooted teeth may involve destruc7on of bone in furca7on area Why is this so important to iden2fy and measure? Bone loss causes furcation Visually, radiographs, probing Measure grade of furcation Normal Not Normal Normal bone levels - bone fully integrated in radicular area Horizontal bone loss - furcation present - plaque retention, difficult to clean, chronic inflammation Measuring furca2ons Looking from the apices of teeth DiNerent entry points All have to be assessed With Nabers probes Nabers Probe Similar to BPE probe First black band 3-6mm Second black band 9-12mm Why is it this pig-tail shape? Wrap around and reach round bolbusities of tooth/roots So it can wrap around Visually Radiographs  Don’t always see this on radiograph because the bone hasn’t been lost enough to expose inter-radicular area. Grade 1 The concavity – just above the furca7on entrance can be detected with 7p of probe Feel entrance to furcation BUT furca7on probe cannot enter furca7on area Evident on Radiograph? Not always visible on radiographs Early stages can be noted Grade 1 Furca2on Radiograph Grade 2 Probe can par7ally enter the furca7on – extending approximately 1/3 the width of the tooth BUT not able to completely pass through furca7on Evident on Radiograph? Yes Grade 2 Furca2on Radiograph Grade 3 In lower molars the probe passes completely through the furca7on- between mesial & distal roots Lowers visible on radiographs due to medial and distal roots In upper molars the probe passes between mesiobuccal & distobuccal roots & touches the palatal root Uppers not visible on radiographs due to palatal root Evident on Radiograph? Grade 3 Furca2on Radiograph Grade 4 Same as Class 3 except the entrance to furca7on is visible clinically owing to 7ssue recession Root caries becomes and issue due to exposed dentine Patients can clean through the furcation Grade 4 image  Grade 4 Grade 1 Grade 3 Grade 2 Compare Nabers Probe access for maxillary teeth Nabers probe access for mandibular teeth What challenges do you meet in trying to access furca2ons? Think variances in morphology What is the problem here? Fused roots - access Kidney bean shaped roots Nabors probe aids with access around the roots Mobility Index  Use mirror and probe handle to measure mobility - fingers can give false readings due to skin movement. Miller (1950) ClassiVca2on Descrip2on CLASS 0 Tooth show mobility of 0.1 – 0.2mm in horizontal direc7on (normal) CLASS 1 Slight mobility, up to 1mm of horizontal displacement in a facial-lingual direc7on CLASS 2 Moderate mobility, greater than 1mm of horizontal displacement in a facial lingual direc7on CLASS 3 Severe mobility, greater than 1mm of displacement in a facial-lingual direc2on combined with ver2cal displacement (tooth depresses into socket) 2 direc2ons of mobility Vertical Horizontal Horizontal tooth mobility Assessing Ver2cal Tooth Mobility