Periodontal Assessment Part 1 PDF

Periodontal Assessments Part 1 Basic periodontal examination - screening tool Founda2ons in Clinical Skills and Prac2ce Sarah Balian GDC Learning Outcomes Intended Learning Outcomes By the end of this session students should be able to:  De#ne the term probing depth  Revise components of...

Periodontal Assessments Part 1 Basic periodontal examination - screening tool Founda2ons in Clinical Skills and Prac2ce Sarah Balian GDC Learning Outcomes Intended Learning Outcomes By the end of this session students should be able to:  De#ne the term probing depth  Revise components of periodontal probing  Revise the limita7ons of periodontal probing  Explain the loca7on and method of undertaking a six point pocket chart  Describe the loca7ons of the free gingival margin  Explain how to measure the free gingival margin  Explain Clinical A?achment Level and its relevance in the periodontal assessment  Explain how to calculate clinical a?achment levels Probing Depth The ‘probing depth’ is the distance from the gingival margin to the bo?om of the pocket. Measured to the nearest millimeter by means of a graduated periodontal probe with a standardised 7p diameter (0.4mm – 0.5mm) Why is probe diameter important? Healthy sulcus vs unhealthy sulcus Healthy gingival sulcus -1-3mm Unhealthy sulcus - pockets 4mm and above Think way back when! Probe Limita7ons features Walking Ergonomics Grip Adapta7on Angula7on 6 Point Pocket Chart (Pre-treatment Periodontal Assessment) 1 Distobuccal line angle to midline of distal surface 2 Buccal surface 3 Mesiobuccal line angle to mesial Midline surface 4 Distolingual line angle to distal surface 5 Lingual surface 6 Mesiolingual angle to midline of mesial surface  Walk around entire surface to find all deep sites What is the issue with the six points terminology? In this example, the deepest reading would be recorded for the buccal reading. Which one is it? A,B or C? C I feel like we do the same site twice… Angulate and visualise What are the limita2ons/errors of probing? Keeps coming back! Have you consolidated the posters? Ar7cle: Periodontal probing: What does it mean? M. A. Listgarten  Pocket, recession, bleeding 32 teeth 6 points = 210 pocket depths Free Gingival Margin False pocketing - increased numbers on placket charting - swollen gingival Some medications cause inflamed gingivae - false pocketing Level of the free gingival margin Gingival margin Gingival margin Natural posi2on (0) covers CEJ (-’ve) Overgrown gingivae - not red - stippled, fibrotic apical CEJ (+’ve) Recession Free gingiva - coronal of CEJ - Healthy Overgrowth from medication - HBP Gingival marking has gone apically of CEJ Drug induced gingival overgrowth (DEGRO) Positive number recorded Causes false pocketing Significantly covers CEJ Measure natural position of CEJ to gingival margin - recorded as negative number. Determining Level of Free Gingival Margin apical to CEJ Cementoenamel junction Reason: Recession Charted as a +‘ve number Measure distance from CEJ to gingival margin To measure recession you do NOT tuck probe into sulcus just rests above gingival margin Determining Level of Free Gingival Margin – coronal to CEJ Subjective to feeling CEJ Distance between CEJ and gingival ‘-ve number’ margin Summary Zero (0) – normal state gingival margin is slightly coronal to CEJ Nega2ve number (-’ve) gingival margin signi_cantly covers CEJ Posi2ve number (+’ve) gingival margin apical to CEJ  Overgrowth - coronal to CEJ Healthy/normal Recession/apical to CEJ - By recording free gingival margin we can truly assess what is going on with the tooth and determine if a pocket is true or not. What does this all mean & why do we need to decipher this informa2on? Probing and free gingival margin positive - when we combining together - clinical attachment levels. Assess true periodontal support around the tooth Clinical Aaachment Levels CAL Clinical aaachment Levels (CAL) Measure of true periodontal support around a tooth CAL provides an es7mate of true periodontal stability & loss of support for a tooth CAL is measured is made from a _xed point on the tooth that does not change and that is the CEJ CAL is cri7cal in dis7nguishing between gingivi7s & periodon77s InYamma7on with no clinical aaachment loss is characteris7c of gingivi2s InYamma7on with clinical aaachment loss is characteris7c of periodon22s Calcula2ng CAL What do we need? 1. Probing depth 2. Level of gingival margin Calcula2ng CAL when gingival margin is at normal level Gingival margin at natural loca7on Probing depth 6mm Gingival margin level 0 Clinical aaachment loss 6mm Calcula2ng CAL when recession is present Gingival margin apical to CEJ = Emm CAL zmm Probing depth 4mm Gingival margin level (+)2mm ↳ mm Clinical aaachment loss 6mm Calcula2ng CAL when gingival margin covers the CEJ Gingival margin covers the CEJ = Som (M co Probing depth 9mm Gingival margin level (-)3mm you Clinical aaachment loss 6mm Example of char2ng Image references Understanding Periodontal Pockets (deardoctor.com) h?ps://dentagama.com/news/gingival-hyperplasia h?ps://www.jisponline.com/viewimage.asp?img=JIndianSocPeriodontol_2014_18_4_516_138747_u2.jpg