Periodontology 2000, Vol.

12, 1996, 33-39

Printed in Denmark . All rights reserved

Copyright 0 M u n k s g a a r d 1996

PERIODONTOLOGY 2000
ISSN 0906-6713

Manual periodontal probing in

supportive periodontal treatment
GARYC. ARMITAGE

Although straight steel probes were in widespread

use by dentists in the early 19OOs, they were primarily used for identifymg the origin and extent of periodontal abscesses (12). In the 1920s, Simonton (63)
and Box (13) first advocated the use of calibrated
periodontal probes to assess the extent of damage to
periodontal structures caused by periodontitis. Over
the next 50 years, measurement of probing depths
gradually came to be recognized as an essential
component of a complete oral examination. Prior to
1970, standard periodontal textbooks placed different degrees of emphasis on the importance of routinely recording probing depths. Most regarded it as
an essential component of a complete periodontal
examination (10, 19, 50, 57, 66, 771, whereas some
suggested that the detailed recording of probing
depths was only necessary prior to surgical procedures (47). Others, however, took a more neutral
position and commented that probing depths could
be measured with a calibrated probe if it was
deemed necessary under the circumstances (24, 25).
Virtually all authors recognized that probing depths
were not necessarily an accurate assessment of the
actual amount of periodontal damage. This view is
quite valid, since the position of the gingival margin,
the reference point from which probing depths are
made, is subject to extensive variability. As will be
seen, the modern view of the diagnostic and clinical
value of probing depth is not radically different from
that suggested by earlier authors.

Types of measurements recorded

by periodontal probes
Calibrated periodontal probes can be used to make
3 different types of measurements: 1) probing depth,
2) clinical attachment level and 3 ) relative attachment level (56).

Probing depth
Probing depth is the distance from the gingival margin to the base of the probeable crevice. It is a clinical approximation of the depth of a periodontal
pocket (5). The primary clinical importance of periodontal pockets is that they are potential habitats for
a pathogenic microbiota. The deeper the pocket, the
more difficult it is for both the therapist and patient
to clean (14, 60, 78). This does not mean, however,
that all sites with deepened probing depths harbor a
pathogenic microbiota. Nor does it mean that all
sites with deepened probing depths need to be surgically reduced. However, data from multiple longitudinal studies indicate that sites with probing
depths of 2-6 mm are at a significantly higher risk of
developing additional attachment loss if left untreated (8, 17, 29, 34, 76). The recording of probing
depths prior to treatment is important because it
gives the clinician a reasonable idea on a site-by-site
basis of where the potential problem areas are
located. Probing depths need to be evaluated in the
context of other clinical findings. For example, a site
with a probing depth of 5 mm with no sign of periodontal infection should be viewed quite differently
than a site of similar depth with bleeding on probing
and suppuration. The latter pocket is, of course, of
more concern than the former, since multiple longitudinal studies indicate that bleeding on probing
and suppuration increase the risk for additional
attachment loss if left untreated (4, 8, 16, 17, 29, 34,
44, 45, 49, 55, 76).
As mentioned above, the primary problem with
probing depth as a clinical measurement is that it
does not necessarily reflect the actual amount of
attachment loss or damage to periodontal structures.
Fluctuations in the position of the gingival margin
may occur during gingival inflammation (swelling)or
in cases of recession. Therefore, changes in position in
both coronal and apical directions make the gingival

33

Armitage

margin an unreliable landmark from which to make

clinical measurements from one visit to the next. This
problem was recognized by clinicians in the past and
was the major reason that some of them did not
strongly advocate the routine recording of probing
depths. For example, Glickman (24) suggested that
merely characterizing the probing depths as slight,
moderate or severe was sufficient for treatment
planning purposes. In his opinion, Determination of
the exact depth in millimeters constitutes little additional information which is of clinical use. The
main difficulty with this approach is that the criteria
for slight, moderate or severe probing depths were not
stated. If treatment decisions are to be based at least
partly 011 probing depths, then it is much better to be
consistent and determine the probing depths in millimeters. Nevertheless, Glickman and most of his contemporaries regarded assessment of loss of attachment as the more reliable measurement of periodontal damage. This view is in complete accord with
current thought on the subject.
Clinical attachment level
Clinical attachment level is the distance from the
cementoenamel junction to the base of the probeable crevice. It is a clinical approximation of the loss
of connective tissue attachment from the root surface (5). This measurement is extremely useful in
clinically monitoring attachment level changes on a
site-by-site basis from one visit to the next. Indeed,
in current clinical practice, clinical attachment level
measurements are the most practical method of assessing treatment outcomes. They are the primary
basis upon which a clinician can be reasonably certain that a program of supportive periodontal treatment is, or is not, working. The primary difficulty
with clinical attachment level measurements is that
they require more skill to obtain than probing
depths, since detection of the cementoenamel junction is necessary. At sites where the gingival margin
is apical to the cementoenamel junction, the measurement is rather easy to record. When the gingival
margin is coronal to the cementoenamel junction,
the clinician must detect the cementoenamel junction through tactile exploration with the probe tip.
This can be difficult, but with practice, the skill can
be mastered.
Relative attachment level
Relative attachment level is the distance from a fixed
landmark, other than the cementoenamel junction,

34

to the base of the probeable crevice. When the

cementoenamel junction is not detectable or is
missing due to a dental restoration, the clinical
attachment level cannot be measured. In such situations, another fixed landmark such as the margin
of a dental restoration or incisal edge of the tooth
can be used as a reference point from which a measurement can be made. Relative attachment level
measurements serve the same purpose as clinical
attachment level measurements, providing a good
estimate of treatment outcomes. Measurements of
relative attachment level are not a new idea, having
been suggested over 50 years ago by Miller, who designed a special probe for this purpose (50).

How accurate are measurements

taken with periodontal probes?
Although measurements taken with periodontal
probes are clinically useful approximations of damage to periodontal structures, periodontal probing
has several sources of error that makes it a somewhat imprecise method of measurement. However,
as will be seen, the measurements are not so imprecise as to negate their clinical usefulness.
Probe penetration and connective tissue
attachment
In the past two decades, numerous studies (2, 3, 15,
20-22, 36, 38, 42, 46, 48, 53, 59, 61, 62, 64, 70-74)
have attempted to establish how accurately measurements of the clinical attachment loss represent
the true position of the connective tissue attachment. Most of these studies either 1) compared preextraction measurements of probing depth or clinical attachment loss with post-extraction estimates
of probe penetration relative to the connective tissue
attachment level (20, 46, 48, 61, 62, 64, 70, 71), or 2)
histologically assessed the extent of probe penetration (2, 3, 20-22, 36, 38, 53, 67, 72, 73). As summarized in Table 1, most studies agree that, at sites with
moderate to severe inflammation, as might be found
in cases of periodontitis, probes penetrated an average of less than 0.5 mm past the apical termination
of the junctional epithelium when gentle insertion
forces (approximately 0.2 to 0.5 N) were used. Most
studies also clearly show that probe penetration increases with higher insertion forces (22, 52, 61, 70,
73) and at inflamed sites (3, 11, 15, 20, 36, 38, 52, 61,
68, 69, 74). At noninflamed sites, such as successfully
treated ones, probes tend to stop coronal to the api-

Manual periodontal probing in supportive periodontal treatment

Table 1. Periodontal probe penetration in relation to connective tissue attachment levels at healthy and
diseased sites

Reference
Armitage et al. (3)

Type of study
Histology, dog

Insertion force"
(25 ponds")

Average distance from probe tip to apical

termination of the junctional epithelium
(mmz SD)
Inflamed or untreated
Healthy or treated
periodontitis
____._.__
-0.39?0.08
f0.24t0.06
(n=40)
(n=40)
ND
+0.27t0.15

Spray et al. (67)

Histology, humans

(15-20 g)

van der Velden

& Jansen (73)
Jansen et al. (38)

Histology, dogs

(0.5 N)

-0.20b
(n=4)

+0.23
(n=4)

Histology, dogs

(Nonstandardized)

ND

+0.50
(n=ll)

Hancock
& Wirthlin (36)
Fowler et al. (20)

Histology, monkeys

(Nonstandardized)

-2.84-tO.87

+0.24 t0.06
(n=7)

(n=10)

- 0.7320.80b
(n=12)
-0.40-C 0.70
(n=lO)
ND

Histology, humans

(0.5 N)

Aguero et al. (2)

Histology, humans

(0.3 N)

Sivertson
& Burgett (64)

Extracted teeth, humans

(Nonstandardized)

Listgarten et al. (46)

Extracted teeth, humans

(Nonstandardized)

Robinson
& Vitek (61)
van der Velden (70)

Extracted teeth, humans

(25 ponds)

- 0.54 20.29

+0.27+0.39

( n2 6 )

Extracted teeth, humans

(0.5 N)

( n2 6 )
ND

Extracted teeth, humans

(Nonstandardized)

+0.2920.50
(n=18

van der Velden (74)

Extracted teeth, humans

(0.75 N)

-0.31 -t0.4gb
(n=ll)
__ -~
-0.09?0.39
(n=32)

Polson et al. (59)

Gingival biopsy, humans

(25 g)

~-

Magnusson
& Listgarten (48)
- - __

+0.45t0.34
(n=15)

__.

+0.17t1.70
(n=8)
+0.08

(n=116)

._

ND

-0.2520.04
(n=22)

+0.30
(n=38)

-0.34t0.97
( n5 4 )

+0.2720.92
(n=26)

ND

"1 gram=l pond=0.0098 newton (N).

bData from treated sites. 'Insertion force for the periodontitis sites not standardized. dA negative sign indicates probe
penetration was coronal to the apical termination of the junctional epithelium. A positive sign indicates probe penetration apical to the apical termination
of the junctional epithelium. ND=not determined.

cal termination of the junctional epithelium (20, 21,

48, 73). Although at individual sites the discrepancy
between clinical attachment loss measurements and
the actual position of the connective tissue attachment may be several millimeters, most of the time
the probe tip penetrates to within 1 mm of the apical
termination of the junctional epithelium.
The clinically important conclusions that can be
drawn from these studies are that 1) probes do not
precisely measure the true level of the connective
tissue attachment, 2) gains in clinical attachment
level after treatment do not necessarily mean that
new connective tissue attachment has been
achieved, and 3) most of the time, clinical attachment level measurements are within 1 mm of the
connective tissue attachment level and are therefore
clinically useful approximations of attachment loss.

Reproducibility of probing measurements

The variables that affect the reproducibility of measurements taken with periodontal probes are well
known: insertion force (18, 22, 52, 701, probe placement and angulation (51, 81, 821, inflammatory status of the tissues (3, 15, 20, 22, 40, 61), diameter of
the probe tip (6, 42) and probe-to-probe variations
in calibration markings (75, 83). Most of these variables can be controlled somewhat in day-to-day
clinical practice situations. If one accepts that some
variation will occur, it is fair to ask whether the process of taking measurements with manual periodontal probes is so flawed that the results are not
clinically meaningful. As will be seen below, measurements carefully taken with periodontal probes
are reasonably reproducible and are meaningful.

35

Arrnitane

In epidemiological and clinical studies measurements taken with periodontal probes are frequently
the maior outcome variable. As a result, many
studies have been conducted to determine whether
measurements of probing depth and clinical attachment loss are reproducible when taken at two different times by experienced clinicians (7, 23, 37, 39, 40,
43, 54, 58, 65, 79, 80). In these studies, perfect agreement (j10.0 mm) for probing depth measurements
ranged from 33 to 70%; for clinical attachment level
measurements the range was 32 to 71.7%; and for
relative attachment level measurements it was 39.8
to 55.4% (Table 2). When the agreement threshold
was set at 21.0 mm, the percentage of agreement
between the first and second examinations dramatically improved with the ranges being: Probing
depth=81.2 to 99.6%,Clinical attachment loss=84 to
98.8%, Relative attachment loss=90 to 94.1% (Table
2). If the agreement threshold was set at 22.0 mm,
the reproducibility of all measurements approached
100%. These findings should be reassuring to practicing clinicians, since they demonstrate that carefully taken measurements with periodontal probes
are reasonably reproducible from one examination
to the next.
In clinical research studies dealing with the etiology of periodontitis, it is important that scientifically

rigorous criteria for progression be used. For example, if one is going to be absolutely certain that a
specific microorganism is associated with the progression of periodontitis, then the criteria used for
progression must be rigidly established. In such
studies, changes in clinical attachment loss measurements are currently the best way to determine
progression. Since the standard deviation of clinical
attachment loss measurements is approximately 1
mm, it has become common practice in most research studies to set the threshold for progression
at 2 to 3 mm times the standard deviation of the
measurement system (1, 9, 26-35, 41, 44, 45). This
means that for a scientist to be certain that progression has occurred, a 2- to 3-mm change in clinical attachment loss must be demonstrated. From a
scientific point of view, this is a completely valid approach. Indeed, it is necessary if any scientifically
valid conclusions are to be drawn.

Interpretation of probing
measurements for patients on
supportive periodontal treatment
Compared with clinical research situations, a very
different set of circumstances exists in day-to-day

Table 2. Intraexaminer reproducibility of probing measurements: probing depth, clinical attachment

level and relative attachment level
~

Percentage agreement between first and second examinationsa

20.0 mm

No. of
sites
1335

Probing
depth

Reference
Glavirid
& Loe (23)
Smith
453
et al. (65)
~Isidor
312
60.9
et al. (37)
_______
Badersten
852
38
ct a l (7)
--__
~67.4
Janssen
1069
et al. (39)
Osborn
156
70
et al. (58)
- -__
Kingman
1867
et al. (43)
Mullally &
656
69.4
Linden (54)
Wang
221
33.0
et
al.
(79)
-~

? L O mm

?2.0 mm

Clinical
Relative
attachattachProbing
ment level ment level depth
99.6

Clinical
attachment level
94.8

Relative
attachProbing
ment level depth
-

81.2

94.5

~-

Clinical
attachment level
-

Relative
attachment level
~-

55.4

95.6

93.9

99.8

99.6

32

42

88

84

90

97

97

97

96.4

99.2

56

99

93

100

71.7

98.8

98.5

39.8

96.4

94.1

99.2

99.5

100
~

- -

'In these ctudier the time interval between the first dnd second examinations ranged from 30 minutes to 3 weeks

- -

Manual periodontal probing in supportive periodontal treatment

clinical practice. It is not reasonable, or in the best

interest of patients, to wait until 3 mm of additional
attachment loss has occurred before clinical intervention is initiated. Clinicians must make treatment
decisions before this much additional damage has
developed. The exact set of clinical conditions that
must be in place before additional treatment is
rendered has not been established. Therefore, clinicians must be guided by the entire clinical picture;
simple reliance on one clinical parameter will not
suffice. For example, if a patient on a supportive
periodontal treatment program experiences a 1-mm
increase in clinical attachment loss without any clinical signs of infection, it should alert the clinician
that a possible problem exists. No special therapeutic intervention may be required, but the site
should be carefully evaluated at the subsequent visit.
On the other hand, a 1-mm increase in clinical
attachment loss at a site with heavy deposits of
plaque and signs of infection most certainly would
prompt the clinician to therapeutically intervene.
This should be the approach even though a 1-mm
change in clinical attachment loss may not be real
since it is within the measurement error of manual
probes. Since a 2-mm increase in clinical attachment loss is within the reliable measurement range
of probing, such a change has a high probability of
being real. In such situations a more aggressive
therapeutic approach may be indicated, such as
shortening the interval at which the patient is being
seen for supportive periodontal treatment. However,
the exact treatment rendered will depend on the entire set of clinical findings. No single clinical finding
should be used as a stand-alone determinant for
making treatment decisions.
Finally, it should be emphasized that in a supportive periodontal treatment program, clinical attachment levels are the best measurements to monitor
the stability of the periodontal tissues. However, if
clinical attachment level measurements have not
been taken, probing depths are a reasonable second-best. The advantage of probing depths is that
they are easy to obtain; the disadvantage is that they
are not as good an indicator of periodontal stability
as clinical attachment level measurements.

References
1. Aeppli DM, Boen JR, Bandt CL. Measuring and interpreting
increases in probing depth and attachment loss. J Periodontol 1985: 56: 262-264.
2. Aguero A, Garnick JJ, Keagle J, Steflik DE, Thompson WO.

Histological location of a standardized periodontal probe

in man. J Periodontol 1995: 66: 184-190.
3. Armitage GC, Svanberg GK, Loe H. Microscopic evaluation
of clinical measurements of connective tissue attachment
levels. J Clin Periodontol 1977: 4: 173-190.
4. Armitage GC, Jeffcoat MK, Chadwick DE, Taggart EJ Jr, Numabe Y, Landis JR, Weaver SL, Sharp TJ. Longitudinal
evaluation of elastase as a marker for the progression of
periodontitis. J Periodontol 1994: 65: 120-128.
5. Armitage GC. Clinical evaluation of periodontal diseases.
Periodonto12000 1995: 7 : 39-53.
6. Atassi Newman HN, Bulman JS. Probe tine diameter and
probing depth. J Clin Periodontol 1992: 19: 301-304.
7. Badersten A, Nilveus R, Egelberg J. Reproducibility of probing attachment level measurements. J Clin Periodontol
1984: 11: 475-485.
8. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical
periodontal therapy. VII. Bleeding, suppuration and probing depth in sites with probing attachment loss. J Clin Periodontol 1985: 12: 432-440.
9. Best AM, Burmeister JA, Gunsolley JC, Brooks CN, Schenkein HA. Reliability of attachment loss measurements in a
longitudinal clinical trial. J Clin Periodontol 1990: 17: 564569.
10. Beube FE. Periodontology. New York Macmillan, 1953:
376-378.
11. Birek r: McCulloch CAG, Overall CM. Measurements of
probing velocity with an automated periodontal probe and
the relationship with experimental periodontitis in the
cynomolgus monkey (Macucu fascicularis). Arch Oral Biol
1989: 34:793-801.
12. Black GV Special dental pathology. 1st edn. Chicago: Medico-Dental Publishing Co., 1915: 371.
13. Box HK. Treatment of the periodontal pocket. Toronto:
University of Toronto Press, 1928: 83.
14. Buchanan SA, Robertson PB. Calculus removal by scaling/
root planing with and without surgical access. J Periodontol
1987: 58: 159-163.
15. Caton J, Greenstein G, Polson AM. Depth of periodontal
probe penetration related to clinical and histologic signs of
gingival inflammation. J Periodontol 1981: 52: 626-629.
16. Chaves ES, Caffesse RG, Morrison EC, Stults DL. Diagnostic
discrimination of bleeding on probing during maintenance
periodontal therapy. Am J Dent 1990: 3: 167-170.
17. Claffey N, Nylund K, Kiger R, Garrett S, Egelberg J. Diagnostic predictability of scores of plaque, bleeding, suppuration
and probing depth for probing attachment loss. 3 1/2 years
of observation following initial periodontal therapy. J Clin
Periodontol 1990: 17: 108-114.
18. Durwin A, Chamberlain H, Renvert S, Garrett S, Nilveus R,
Egelberg J. Significance of probing force for evaluation of
healing following periodontal therapy. J Clin Periodontol
1985: 12: 306-311.
19. Fish EW. Periodontal disease. A manual of treatment and
atlas of pathology. London: Eyre and Spottiswoode Publishers, 1946: 59.
20. Fowler C, Garrett S, Crigger M, Egelberg J. Histologic probe
position in treated and untreated human periodontal
tissues. J Clin Periodontol 1982: 9: 373-385.
21. Garnick JJ, Spray JR, Vernino DM, Klawitter JJ. Demonstration of probes in human periodontal pockets. J Periodontol 1980: 51: 563-570.
22. Garnick JJ, Keagle JG, Searle JR, King GE, Thompson WO.

37

Gingival resistance to probing forces. 11. The effect of inflainriiation and pressure on probe displacement in beagle
dog gingivitis. J Periodontol 1989: 60: 498-505.
23. Glavind L, Loe H. Errors in the clinical assessments of periodontal destruction. J Periodont Res 1967: 2: 180-184.
24. Glickman I. Clinical periodontology. 1st edn. Philadelphia:
W.B. Saunders Co., 1953: 550.
25. Goldrnan HM. Periodontia. 2nd edn. St. Louis: C.V. Mosby
Co., 1949: 282.
26. Goodson JM, Tanner ACR, Haffajee AD, Sornberger GC,
Socransky SS. Patterns of progression and regression of advanced destruction periodontal disease. J Clin Periodontol
1982: 9: 472-481.
27. Goodson JM. Clinical measurements of periodontitis. J Clin
Periodontol 1986: 13: 446-455.
28. Goodson JM. Diagnosis of periodontitis by physical measurement: interpretation from episodic disease hypothesis.
I Periodontol 1992: 63: 373-382.
29. Grbic IT, Lamster IB. Risk indicators for future clinical
attachment loss in adult periodontitis. Tooth and site variables J Periodontol 1992: 63: 262-269.
30. Gunsolley JC, Best AM. Change in attachment level. J Periodontol 1988: 59: 450-456.
31. Haffajee AD, Socransky SS, Goodson JM. Clinical parameters as predictors of destructive periodontal disease activity. J Clin Periodontol 1983: 10: 257-265.
32. Haffajee AD, Socransky SS, Goodson JM. Comparison of
different data analyses for detecting changes in attachment
level. J Clin Periodontol 1983: 10: 298-310.
33. Haffajee AD, Socransky SS, Lindhe J, Kent RL, Okamoto H,
Yoneyama T. Clinical risk indicators for periodontal attachment loss. J Clin Periodontol 1991: 18: 117-125.
34. Haffajee AD, Socransky SS, Smith C, Dibart S. Microbial risk
indicators for periodontal attachment loss. J Periodont Res
1991: 26: 293-296.
35. Haffajee AD, Socransky SS, Smith C, Dibart S. Relation of
baseline microbial parameters to future periodontal
attachment loss. J Clin Periodontol 1991: 18: 744-750.
36. Hancock EB, Wirthlin MR. The location of the periodontal
probe tip in health and disease. J Periodontoll981: 52: 124129.
37. Isidol- F, Karring T, Attstrom R. Reproducibility of pocket
depth and attachment level measurements when using a
flexible splint. J Clin Periodontol 1984: 11: 662-668.
38. Jansen J, Pilot T, Corba N. Histologic evaluation of probe
penetration during clinical assessment of periodontal
attachment levels. An investigation of experimentally induced periodontal lesions in beagle dogs. J Clin Periodontol 1981: 8: 98-106.
39. Janssen PTM, Faber JAJ, van Palenstein Helderman WH.
Non-Gaussian distribution of differences between duplicate probing depth measurements. J Clin Periodontol 1987:
14: 345-349.
40. Janssen PTM, Faber JAJ, van Palenstein Helderman WH. Effect of probing depth and bleeding tendency on the reproducibility of probing depth measurements. J Clin Periodontol 1988: 15: 565-568.
41. Kaldahl WB, Kalkwarf KL, Patil KD, Molvar Ml? Relationship
of gingival bleeding, gingival suppuration, and supragingival plaque to attachment loss. J Periodontol 1990: 61:
347-351.
42. Keagle JG, Garnick JJ, Searle JR, King GE, Morse PK. Gingival resistance to probing forces. I. Determination of optimal probe diameter. J Periodontol 1989: 60: 167-171.

43. Kingman A, Loe H, h e r u d A, Boysen H. Errors in measuring parameters associated with periodontal health and disease. J Periodontol 1991: 62: 477-486.
44. Lang NP, Joss A, Orsanic T, Gusberti FA, Siegrist BE. Bleeding on probing. A predictor for the progression of periodontal disease? J Clin Periodontol 1986: 13: 590-596.
45. Lang NP, Adler R, Joss A, Nyman S. Absence of bleeding on
probing. An indicator of periodontal stability. J Clin Periodontol 1990: 17: 714-721.
46. Listgarten MA, Mao R, Robinson PJ. Periodontal probing
and the relationship of the probe tip to periodontal tissues.
J Periodontol 1976: 47: 511-513.
47. Macphee T, Cowley G. Essentials of periodontology and
periodontics. Oxford: Blackwell Scientific Publications,
1969: 112-113.
48. Magnusson I, Listgarten MA. Histological evaluation of
probing depth following periodontal treatment. J Clin Periodontol 1980: 7: 26-31.
49. Magnusson I, Marks RG, Clark WB, Walker CB, Low SB,
McArthur WP Clinical, microbiological and immunological
characteristics of subjects with refractory periodontal
disease. J Clin Periodontol 1991: 18: 291-299.
50. Miller SC. Textbook of periodontia. 2nd edn. Philadelphia:
Blakiston Co., 1943: 222-225.
51. Mintzer RE, Derdivanis Jl? Automated periodontal probing
and recording. Curr Opin Periodontol 1993: 60-66.
52. Mombelli A, Muhle T, Frigg R. Depth-force patterns of periodontal probing. Attachment-gain in relation to probing
force. J Clin Periodontol 1992: 19: 295-300.
53. Moriarty JD, Hutchens LH, Scheitler LE. Histological evaluation of periodontal probe penetration in untreated facial
molar furcations. J Clin Periodontol 1989: 16: 21-26.
54. Mullally BH, Linden GJ. Comparative reproducibility of
proximal probing depth using electronic pressure-controlled and hand probing. J Clin Periodontol 1994: 21: 284288.
55. Muller H-P, Heinecke A, Lange DE. Postoperative bleeding
tendency as a risk factor in Actinobacillus actinornyceterncomitans-associated periodontitis. J Periodont Res 1993:
28: 437443.
56. Nevins M, Becker W, Kornman K, ed. Proceedings of the
World Workshop in Clinical Periodontics. Chicago: American Academy of Periodontology, 1989: 1-23.
57. Orban B. Periodontics. A concept - theory and practice. 1st
edn. St. Louis: Mosby, 1958: 188-190, 512-513.
58. Osborn J, Stoltenberg J, Huso B, Aeppli D, Pihlstrom B.
Comparison of measurement variability using a standard
and constant force periodontal probe. J Periodontol 1990:
61: 497-503.
59. Polson AM, Caton JG, Yeaple RN, Zander HA. Histological
determination of probe tip penetration into gingival sulcus
of humans using an electronic pressure-sensitive probe. J
Clin Periodontol 1980: 7: 479-488.
60. Rabbani GM, Ash MM, Caffesse RG. The effectiveness of
subgingival scaling and root planing in calculus removal. J
Periodontol 1981: 52: 119-123.
61. Robinson PJ, Vitek RM. The relationship between gingival
inflammation and resistance to probe penetration. J Periodont Res 1979: 14: 239-243.
62. Saglie R, Johansen JR, Flntra L. The zone of completely and
partially destroyed periodontal fibers in pathological
pockets. J Clin Periodontol 1975: 2: 198-202.
63. Simonton FV Examination of the mouth - with special reference to pyorrhea. J Am Dent Assoc 1925: 12: 287-295.

Manual periodontal probing in supportive periodontal treatment

64. Sivertson JE Burgett FG. Probing of pockets related to
attachment level, J Periodontol 1976: 47: 281-286.
65. Smith LW, Suomi JD, Greene JC, Barbano JP A study of intra-examiner variation in scoring oral hygiene status, gingival inflammation and epithelial attachment level. J Periodontol 1970: 41: 671-674.
66. Sorrin S. The practice of periodontia. New York McGrawHill, 1960: 125.
67. Spray JR, Garnick JJ, Doles LR, Klawitter JJ. Microscopic
demonstration of the position of periodontal probes. J Periodontol 1978: 49: 148-152.
68. Tessier J-F, Ellen Rf: Birek P, Kulkarni GV, McCulloch CAG.
Relationship between periodontal probing velocity and
gingival inflammation in human subjects. J Clin Periodontol 1993: 20: 41-48.
69. Tessier 1-F, Kulkarni GV, Ellen RP, McCulloch CAG. Probing
velocity: novel approach for assessment of inflamed periodontal attachment. 1 Periodontol 1994: 65: 103-108.
70. van der Velden U. Probing force and the relationship of the
probe tip to the periodontal tissues. J Clin Periodontol
1979: 6: 106-114.
71. van der Velden U. Influence of periodontal health on probing depth and bleeding tendency. J Clin Periodontol 1980:
7: 129-139.
72. van der Velden U, Jansen J. Probing force in relation to
probe penetration into the periodontal tissues in dogs, A
microscopic evaluation. J Clin Periodontol 1980: 7: 325327.
73. van der Velden U, Jansen J. Microscopic evaluation of
pocket depth measurements performed with six different
probing forces in dogs. J Clin Periodontol 1981: 8: 107-116.
74. van der Velden U. Location of probe tip in bleeding and

non-bleeding pockets with minimal gingival inflammation.

J Clin Periodontol 1982: 9: 421-427.
75. van der Zee E, Davies EH, Newman HN. Marking width,
calibration from tip and tine diameter of periodontal
probes. J Clin Periodontol 1991: 18: 516-520.
76. Vanooteghem R, Hutchens LH, Garrett S, Kiger R, Egelberg
J. Bleeding on probing and probing depth as indicators of
the response to plaque control and root debridement. J
Clin Periodontol 1987: 14: 226-230.
77. Wade AB. Basic periodontology. Bristol: John Wright &
Sons, 1960: 183-184.
78. Waerhaug J. Healing of the dento-epithelial junction following subgingival plaque control. 11. As observed on extracted teeth. J Periodontol 1978: 49: 119-134.
79. Wang S-F, Leknes KN, Zimmerman GI, Sigurdsson TJ,
Wikesjo UME, Selvig KA. Reproducibility of periodontal
probing using a conventional manual and an automated
force-controlled electronic probe. J Periodontol 1995: 66:
38-46.
80. Wang S-F, Leknes KN, Zimmerman GJ, Sigurdsson TJ,
Wikesjo UME, Selvig KA. Intra- and inter-examiner reproducibility in constant force probing. J Clin Periodontol
1995: 22: 918-922.
81. Watts T. Constant force probing with and without a stent in
untreated periodontal disease: the clinical reproducibility
problem and possible sources of error. J Clin Periodontol
1987: 14: 407-411.
82. Watts TLP Probing site configuration in patients with untreated periodontitis. A study of horizontal positional error.
1 Clin Periodontol 1989: 16: 529-533.
83. Winter AA. Measurement of the millimeter markings of
periodontal probes. J Periodontol 1979: 50: 483485.

39