Perio Probe for periodontal probing
Periodontal probing is the gold standard of examination in periodontium and is necessary to assess the condition of periodontal tissues.It is necessary to measure the level of gum attachment, to determine the degree of previous or current activity of periodontal diseases and to assess the effectiveness of the treatment. It can be used to accurately locate, evaluate and measure the depth of the sulcus and periodontal pocket. Various periodontal probes are currently available that differ in labeling, coding, diameter, material and angle.
Key Points of Article
- What is Periodontal Probing
- Function of the periodontal probe
- Factors affecting Periodontal Probing
- How to maximize the Accuracy of results
What is Periodontal Probing
Periodontal probing is used to record the depth of existing periodontal pockets and to assess the loss of the level of periodontal attachment. An increase in probing depth over time may indicate the need for additional diagnostic studies such as radiography or checking the level of the bone ridge.
Clinical probing depth is the distance that the probe can penetrate into the gingival groove or periodontal pocket.
clinical probing is a non-invasive approach that can provide the necessary information about the level of periodontal attachment loss and in the presence of inflammation of the tissues surrounding the tooth.
Function of the periodontal probe
The primary function of the periodontal probe is to detect periodontal pockets in order to determine the health of the periodontium. As early as 1958, the periodontist BJ Orban described the periodontal probe as the "doctor's eye under the gingiva" and thus demonstrated the importance of a complete periodontal examination. But what else does the probe show us?
Recording of the probing depth (ST), gingival course and attachment level (CAL) for the periodontal status
Feeling of protruding filling edges
Palpation of subgingival concretions and subgingival roughness
BOP (bleeding on probing) as a sign of inflammation.
The probe is therefore the most important clinical tool for determining the following parameters:
Total attachment loss
Width of the attached gingiva
Tendency to bleed during probing - the BOP (Bleeding on Probing).
Factors affecting Periodontal Probing
Periodontal pocket depth is measured to the millimeter value using a graduated periodontal probe with a standard working tip diameter of approximately 0.4 mm to 0.5 mm. In this case, the measurement indicators are influenced by such parameters as:
the thickness of the probe used;
angular positioning of the instrument depending on the anatomical features (photo 1 - 3),
the probe graduation scale,
the pressure applied to the instrument during probing;
the degree of inflammatory cellular infiltration of soft tissues and the concomitant loss of the collagen component.
How to maximize the Accuracy of results
Periodontal probing is the next step after clinical observation during examination. It makes it possible to record two measurements: the depth of the pocket and the level of clinical attachment and to note the damage of furcation.
Mobility is also assessed at this stage.
The pocket depth (PPD Probing Pocket Depth) designates the distance separating the top of the marginal gingiva from the bottom of the pocket, while the PAL Probing Attachment Level represents the distance separating the enamel - cement junction from the bottom pocket, the difference between the two measurements being gum recession.
Just like signs of gingival inflammation, these measurements can be taken on the vestibular, lingual and palatal surfaces, as well as mesial and distal surfaces of all teeth. A few teeth can be chosen from each hemiarch to ease the protocol in daily practice.
There are many factors that vary in the recording of these measurements (Listgarten 1980), the thickness and position of the probe, the pressure exerted by the examiner, and the degree of inflammation.
This is why all measurements must be made by the same practitioner and excessive penetration of the probe into the inflammatory tissue must be avoided.
Small resin guides can be used to locate the exact site and axis of probing at different stages of periodontal treatment. This makes it possible to standardize the probing to evaluate the evolution of a lesion or the results of a treatment.
Constant pressure probes (20 grams at the end of the probe (Polson et al 1980)) can be used.
It should be noted that gingivitis can cause gingival growth and therefore a pseudo-pocket of 3 to 4 mm without apical migration of the junctional epithelium. Attachment loss can occur without deepening the pocket depth through gingival recession. These measurements will be recorded on a chart or "charting" and will be repeated at the end of the treatment to assess their effects.
On this table, furcation attacks will also be noted. The simplest classification designates a class 1 interradicular impairment when the horizontal bone loss does not exceed 1/3 the width of the tooth, class 2 when it exceeds 1/3 without passage of the probe and class 3 when the attack is through and through (Lindhe 1998).
The periodontal probe can be replaced by a Nabers curved probe but its passage may be hampered by a budding of the inflammatory gingiva. On mandibular molars, probing is performed on the buccal and lingual surfaces, while on maxillary molars, it will be done on the buccal, then mesial and distal surfaces.
Where to probe?
The probing depth is therefore a measure of the depth of a sulcus or a periodontal pocket. It is determined by measuring the distance from the gum line to the sulcus floor or pocket floor. These measurements are recorded in six specific areas on each tooth:
Why six measuring points?
Well, there are often cases where the breakdown of the periodontium is not horizontal. A measurement with only two measuring points, for example from the buccal always mesial and distal, then only shows an inadequate and imprecise picture of the periodontal situation. It can happen that from the buccal all probing depths are unremarkable (1-3 mm), but the oral picture shows a completely different picture - often seen in smokers. A comprehensive six-point measurement is therefore essential.
A reliable probing technique requires a slight pressure of 0.25 N. The distance that a periodontal probe covers until there is a noticeable resistance at the bottom of the pocket depends on various factors.
The diameter of the probe
The degree of inflammation of the gum tissue
On the tissue strength of the marginal epithelium
On the density of the connective tissue fibers in the teeth supporting structure.
Reliable results are obtained when the probe is guided through the gingival pocket / sulcus with "walking" movements (walking probe). Seen in imagination like a “walk”, in up and down movements in a systematic sequence around the tooth. The shaft of the probe is at an angle of approx. 10-15 degrees to the tooth surface, i.e. as parallel as possible to the tooth axis, and touches the contact surface areas. Incorrect readings result if the periodontal probe is held too steep or too flat. Studies have shown that incorrect measurements are in the range of 0.5-2 mm and can therefore lead to very large differences.
Perio Probe Varioue Types
Periodontal probing is the gold standard of examination in periodontium and is necessary to assess the condition of periodontal tissues.It is necessary to measure the level of gum attachment, to determine the degree of previous or current activity of periodontal diseases and to assess the effectiveness of the treatment.
It can be used to accurately locate, evaluate and measure the depth of the sulcus and periodontal pocket. Various periodontal probes are currently available that differ in labeling, coding, diameter, material and angle.
The first periodontal probes of this generation are conventional or hand-held probes made of stainless steel or plastic. They do not have a special device to measure pressure or force used by periodontist during probing.
The working end of these probes is round, conical, flat or rectangular with smooth, rounded ends. Calibrations in millimeters are carried out at different intervals, which makes it easier to measure the depth of the pocket.
The working end of the probe can be curved to facilitate probing in the bifurcation region. The diameter of the probe is important because if it is larger it is difficult to insert it into the pocket and may not reach the bottom; if it is too thin, it can invade the junctional epithelium, giving a false indication.
There is no standardized pressure applied to first generation probes. It has been shown that the pressure applied during the sounding affects the readings obtained, which can cause an error in the readings depending on the pressure applied during the sounding by the same or different operators.
To overcome this problem, second generation probes have been developed to standardize and quantify the pressure used during sounding. These probes are pressure sensitive to improve the standardization of the probing pressure. It was shown that the probing pressure should not exceed 0.2 Nm / m2. These probes can be easily used in clinical practice without the need for computerized surgery.
The limitations of the second generation probes included errors in applying constant pressure, errors in readings, errors in calculating insertion loss into the probe structure, and there was no automatic recording system available to store the acquired data. Probes of the third generation belong to automated sensing systems, where, along with the application of constant pressure, data are stored on a computer. Operator errors are eliminated in these devices.
The fourth generation probes use 3D technology to provide accurate and continuous readings of the gingival sulcus or pocket. These probes are currently under development.
They are designed to record sequential probe positions along the sulcus or pocket. Visualization in 3 D format can provide us with fairly accurate information about the pocket.
In addition to 3D technology, these probes are designed for ultrasound use. These are non-invasive probes. The advantage of using ultrasound waves is to accurately measure attachment levels without penetrating the connective tissue epithelium.
The main disadvantage of traditional probes is the overestimation of the pocket depth due to the penetration of the probe tip into the connective tissue, especially during inflammation. The only available 5th generation probe is the Ultra Sonographic Probe (USA) (Visual Programs, Inc,)
Ultrasonic vs. hand instrumentation in periodontal therapy: clinical outcomes
When a probe goes in search
Risks and benefits of probing around teeth and dental implants
Periodontal Probe in the examination of periodontal diseases.
How to examine the periodontium? Paul Mattout