Conventional/advanced perio/implant diagnostics Flashcards
What parts of a visual inspection are important for diagnosing perio and periimplantitis?
Visual signs of inflammation (Redness, Heat, Swelling, Pain, Loss of function), color differences between KG and AM (Orban 1948)
Plaque, Calculus (Low 1967)
What are the traditional clinical diagnostic parameters for perio/periimplantitis?
PD, REC, CAL, BOP, MGJ, Furcation, Mobility,
What statistics are the for BOP
98% Negative Predictive Value (No BOP - No disease)
BOP+ Does not mean disease (Lang 1990)
What does recession indicate?
Traumatic habit
History of Perio
Jepson 2018
What does CAL tell us
Strong predictor of future breakdown (Van der Velden et al. 2006)
Key criterion for stage/grading (Tonetti)
How does furcation involvement effect tooth-loss risk?
2x risk for molar loss (Nibali et al. 2016)
Questionable prognosis (Becker)
What limitations does a prob have? What is the Probing error?
Measurements can vary: Inter-examiner difference in Force, Angle, Reading error, Proficiency, deeper pockets
0.8mm (Goodson et al. 1984)
What is the name of the pressure controlled probe?
the Florida Probe
How is BOP different for Implants?
Not as good an indicator.
0.5N force reaches 0.7mm further on healthy implant (Armitage et al. 1977)
Prob can reach CT in health (Lang et al. 1994)
What other methods are there for testing mobility?
Periotest (little hydrolic hammer)
How do you measure gingival thickness?
Probe transparency (Rasperini) (Kan 2010)
Transgingival probing
What differentiates peri-implant mucositis from peri-implantitis?
progressive loss of supporting bone
Berglundh 2018
What are inaccuracies of radiographs?
30% loss of mineral density has to occur before it shows up (Ortman et al. 1982)
Attachment loss precedes bone loss by 6-8mo (Goodson 1984)
What does presence of Lamina Dura indicate? Lack of LD?
Presence is a good indicator for health
Absence does not mean disease (Rams et al. 1994)
Presence had 100% Negative Predictive Value for bone loss at 24mo
What are downfalls of CBCT?
slight inaccuracy (low accuracy of buccal bone measurement if <1mm) Gonzalez-Martin 2016
High radiation dose
What visualizing method is advantages about US?
BMode - cross sectional, anatomical imaging - can visualize the anatomical structures of perio soft and hard tissues
How does ultrasound generate an image?
Based on:
reflection, scattering, and attenuation
each pixel is assigned a grey scale of the amplitude of the echo.
What does Color Flow do for us?
allows a visual inspection of tissue perfusion and inflammation in the scanned area
What does red and blue indicate in color flow?
Red - toward ROI
Blue - Away from ROI
How can color flow show inflammation?
Can quantify visible blood vessel density as a surrogate for the degree of inflammation.
What applications are there for US?
implant planning, intraoperative, post-op monitoring.
Eval of vital structures
Hard and soft tissue dimension (Chan et al. 2020)
Peri-implant health status (Barootchi et al. 2021)
What biomarker has the best sensitivity and specificity?
Kinney et al. 2014
Saliva: 93/26
GCF: 23/95
Saliva + GCF + plaque + PDs: 70/70
What are 1st generation probes?
Manual probes
What are 2nd generation probes?
Constant force probes (Armitage 1977 0.25N)
What are third generation probes?
Constant force with computer assistence (florida probe)
What are 4th generation probes?
3d probes - sequential probe positions are measured
What are 5th generation probes
3D and non-invasive - Ultrasound
What is the probing error and why?
0.8mm Goodson 1986
Angle, pressure, inflammation, tooth surface
What is the sensitivity, specificity, and NPV of BOP?
Lang 1990
29%
88%
98%
When is BOP significant?
When it happens at multiple visits
Lang 1990 - sites with BOP at 5/6 visits had 2mm attachment loss
How is pain associated with probing?
Pain is related to level of inflammation (Newcomb 2015)
What pathologies are associated with a narrow PDL?
Hypophosphotemic rickets
Fibrous displaysia
Ankylosis
What pathologies are associated with widened PDLs?
GOSH TB
TFO,
osteosarcoma,
Scleroderma,
BRON/J,
hyperparathyroidism,
Gaucher’s Disease
How accurate is a furcation arrow?
Sensitivity of 38.7%
Deas et al. 2006
How can we grade vertical furcation involvement?
Tarnow & Fletcher (10yr survival)
A: 0-3mm (91%)
B: 4-7mm (67%)
C: 7+mm (23%)
Tonetti 2017 (thirds)
What is the OR of losing a tooth depending on vertical furcation?
9.83 Type A vs Type B/C
Nibali et al
What are some inflammatory biomarkers?
IL1
IL4
IL6
IL8
IL10
TNFa
What are some tissue destruction biomarkers?
MMPs (Collagenases/Gelatinases)
TIMPs
TGFb
Aspartate aminotransferase (dead/dying cells)
What are some biomarkers related to bone remodeling?
RANKL
OPG
CTIP (fragmant of bone - type I COL)
How heritable is periodontitis?
50%
Michalowicz et al. 2000
Increases with severity (Nibali et al 2019)
What gene is predictive of severe perio?
IL1 genotype: OR 18.9 for severe perio
Kornman et al1997
What are some new forms of imaging?
CBCT
Laser dopler flowtrometry
Ultrasound
Optical Coherence Tomography
What is LDF? How does it work?
Real time technique for continues measures of blood perfusion
Dopler shift - change in wavelength due to reflection off moving objects (red blood cells)
What is a benefit of LDF
No contact with tissue - no compression
What is OCT? How does it work?
Optical Coherence Tomography
Uses a lightly focused near infrared light to provide high rez cross sectional images
