Periodontal Assessments Part 1 PDF

Periodontal Assessments Part 1 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 pe...

Periodontal Assessments Part 1 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 enamal un probeespiral - 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 define (0.4mm – 0.5mm) - Why is probe diameter important? Healthy sulcus vs unhealthy sulcus Probing depth over 4mm Probe inserted into healty sulcus - 0-3mm Indicates periodontal pocket Unhealthy sulcus Think way back when! Probe Limita7ons features Walking Ergonomics Impact on probing Grip Adapta7on Angula7on 6 Point Pocket Chart (Pre-treatment Periodontal Assessment) Occlusal view of molar 1 Distobuccal line angle to midline of distal surface 2 Buccal surface 3 Mesiobuccal line angle to mesial surface 4 Distolingual line angle to distal surface 5 Lingual surface 6 Mesiolingual angle to midline of mesial surface What is the issue with the six points terminology? It is more that 6 points. The probe needs to enter the gingival sulcus more than 6 times. This is why you do a walking stroke, mm by mm.This is to ensure no pockets are missed if present.  In this example, the deepest reading would be recorded for the buccal reading. Which one is it? C A,B or C? ⑧ I feel like we do the same site twice… Bone levels vary in this small space. under -overage e 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  32 teeth 6 points = 210pocket depths 32 teeth 6 points = 210 This is charted like so… pocket depths Free Gingival Margin Level of the free gingival margin Gingival margin Gingival margin Natural posi2on (0) covers CEJ (-’ve) apical CEJ (+’ve) Free gingiva sitting coronal to CEJ Overgrown gingiva Gingival recession Neutral position so scoring is 0 Gingiva margin covers CEJ Gingival margin has gone apically Measure from gingival margin This is messaged as a positive number To CEJ - this measure t is measured as Eg +2 or 2 A negative number eg -2 Determining Level of Free Gingival Margin apical to CEJ Reason: Recession Charted as a +‘ve number 3 + ar [3 Don’t go into sulcus for recession measurements Want to be onto of gingival margin Determining Level of Free Gingival Margin – coronal to CEJ Feel for CEJ ! From gingival margin to CEJ Distance between CEJ and gingival ‘-ve number’ margin & I-4mm - 2 mm 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 present Recession present Normal Normal Gingival recession Overgrowth of Gingiva What does this all mean & why do we need to decipher this informa2on? 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 Add two together Gingival margin apical to CEJ Probing depth 4mm Gingival margin level (+)2mm Clinical aaachment loss 6mm Calcula2ng CAL when gingival margin covers the CEJ Minus gingival margin level from probing depth Gingival margin covers the CEJ Probing depth 9mm Gingival margin level (-)3mm 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