Diagnostic Methods Flashcards
Conventional vs advanced diagnostic methods
Conventional:
* inflammation status
* probing
* BOP
* x-rays
* mobility, furcation
Advanced:
* biomarkers (oral fluid)
* CBCT
* Ultrasound
Clinical parameters
Evaluate attached gingiva
Visual assessment (color)
Schillers iodone solution (mucosa glycogen stains)
Roll technique (probe)
KT for gingival health?
Lang &Loe 1972: YES (at least 2mm KT and 1mm AG
Cortellini and Bissada 2018 (AAPWW): a minimum amount of KT is NOT needed, so long as adequate oral hygiene
Stippling
Rete peg invagination into CT
Karring and Loe 1970
Approx 40% of pop, sign of health (Green 1962)
1st gen probe:
A) Marquis color-coded probe. Calibrations are in 3-mm sections.
B) University of North Carolina-15 probe, a 15-mm long probe with millimeter markings at each millimeter and color coding at the fifth, tenth, and 15mm.
C) University of Michigan “O” probe, with Williams markings (at 1, 2, 3, 5, 7, 8, 9, and 10 mm).
D) Michigan “O” probe with markings at 3, 6, and 8 mm.
E) CPITN probe, World Health Organization (WHO) probe, which has a 0.5-mm ball at the tip and millimeter markings at 3.5, 8.5, and 11.5 mm and color coding from 3.5 to 5.5 mm
CP-11 color-coded single end probe 3,6,8,11 mm (used in VIC’s)
Other probes
2nd gen: constant force controlled pressure probes
3rd gen: constant force plus computer assisted probe
4th gen: 3D probes
5th gen: Ultrasonographic prob
Probe force
0.25-0.75 N
Van der Valden 1978
Probe design
flat (original)
rounded tip (current)
0.5 mm common
probe stop location
Goodson et al 1986
Factors affecting probing accuracy
force, angulation, inflammation, tooth surface
Average error: 0.8mm
BOP
Lang 1986
Abscene of BOP: NPV 98-99%
prescence of BOP: poor predictor
Furcation involvement
Hamp Nyman and Lindhe 1975
horizontal
Class 1: <3mm
Class 2: >3mm not through
Class 3: Through and through
Furcation involvement
vertical
Tonetti et al 2017 (AAPWW)
A: coronal third of root
B: middle third of root
C: apical third of root
Lamina Dura
Rams et al 1994
prescence of lamina dura has 100% PPV for stability
Crestal bone loss
Ortman et al 1982
minimum change needed to detect change is 30%
Radiographs underestimate degree of bone loss in early cases (<30%) but overestimates in advanced bone loss (>60%)
PDL space
Widened in:
1. TFO
2. osteosarcoma
3. scleroderma
4. BRONJ
5. hyperparathyroidism
6. Gaucher’s disease
Narrowed in:
1. Hypophosphatemic rickets
2. fibrous dysplasia
3. ankylosis
Calculus detection by xray
Only detected 44% of time
Buchanan et al 1987
Cemental tear detection by xray
Lin et al 2011
56% detection
Furcation arrow detection
Deans et al 2006
Sn: 38%
Sp: 92%
PPV: 72%
NPV: 75%
Name furcation arrow proposed by Hardekopf et al 1987
CBCT
AAP best evidence review
Kim and Bassir 2017
non-invasive, accurate alternative to surgical exploration for vertical defects
give a more clear vision (0.1mm accuracy) of furcations than Nabers probes (0.5mm accuracy)
CBCT was bad at estimating peri-implant bucal bone thickness, especially when thin <1mm (Gonzales-Martin et al 2016)
Ultrasound advantages
Ultrasound B-mode (static)
Cross sectional anatomical image of soft and hard tissue
Ultrasound dynamic image (Color mode)
color flow images assess veolocity of blood
tissue perfusion
red color is flow to region of interest
blue color is blood moving away from region of interest
Tattan et al 2022
3D ultrasound was comparable to CBCT at estimating ridge width
imaging pros and cons
Biomarkers
saliva and GCF are common periodontal biomarkers
Kinney et al 2014
periodontal biomarkers
saliva high Sn
GCF high Sp
Combined GCF and saliva 70% Sn and Sp
Artificial intelligence
Revilla-Leon et al 2022
plaque: accuracy 74-99%
Gingivitis from photographs: accuracy 74-78%
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