Periodontalprobes 111126073559 Phpapp01

PERIODONTAL PROBES
KRUPESH RAJANI
Index
2
 Introduction
 History
 Standard Periodontal Probe
 Classification
 Types of Periodontal Probe
 Probing technique
 When to probe
 Pocket probing
 Thermal Probe
 Pressure Sensitive Probe
Periodontal Probes 18/03/2010
Index
3
 NIDCR Criteria
 Florida Probing System
 Florida Probing System for assessment of Clinical
Attachment Levels (CAL)
 Periimplant Probing
 Conclusion
 References

Introduction
4
 Periodontal probes are used to locate, measure, and

mark pockets, as well as determine their course on
individual tooth surfaces.
 Periodontal probes are used to measure the depth of

pockets and to determine their configuration.

History
5
 The third edition of G.V.Black’s Special Dental

Pathology published in 1924 after his death
mentions “the use of very thin flat explorers to
determine the depth of pockets”. These instruments
were not calibrated and they were not used for
decades.
 Periodontal probe and its use was first described by
F.V. Simoton of the University Of California, San
Francisco in 1925.

History
6
 Simoton refers the periodontal probe as a

“Periodontiometer” and credits W.H.Hamford and
C.O.Patten for its invention.
 Acceptance of routine periodontal probing in

diagnosis was slow. Periodontal books published in
1930s makes brief mention of probes and probing,
and the charts they proposed had no space for
“pocket depth recordings”.

Standard Periodontal Probe
7
•The typical probe is a tapered, rod-like instrument

calibrated in millimeters, with a blunt rounded tip.

Classification
8
 Periodontal probes may be divided into:

 First generation probes are conventional,
and hand held probes, e.g. conventional periodontal
probes.
 Second generation probes are pressure –sensitive
probes. It has been shown that, with forces up to
30gms the probe tip remains within junctional
epithelium and forces up to 50gms are necessary to
diagnose osseous defects. This probe did solve
many problems of the conventional probes, but
lacked tactile sensitivity.

Classification
9
 Third generation probes are computerized

probes. Gibbs et al designed Florida probe. E.g.-
Foster Miller Probe, Toronto Automated Probes,
which can detect the cemento-enamel junction.
 Fourth generation probes are the three
dimensional probes in which sequential probe
positions are measured.
 Fifth generation probes are ultrasonographic
probes which provides painless probing to the
patient. The guidance path is predetermined in these
probes.

Types Of Periodontal Probes
10
There are three types of periodontal

probes. They are:
3. Calibrated periodontal probes
4. Naber’s furcation probe
5. Computer assisted probes

Explorers
11
An explorer is an assessment instrument

with a flexible wire like working-end.
Assessment instruments like periodontal

probes and explorers are used to
determine health of periodontal tissues,
tooth anatomy, and texture of tooth
surfaces.

Explorers
12
 Design of explorers:
1. Explorers are made up of flexible metal that
conducts vibrations from the working end to the
clinician’s fingers on instrument shank and handle.
2. Circular in cross-section.
3. Working end is 1-2mm in length and is referred to
as the explorer tip.
4. The actual point of the explorer is not used to
detect the calculus, rather the side of the explorer tip
is applied to the tooth surface.

Explorers
13
 Function of explorers:
1. Explorers are used to detect, by tactile means, the
texture and character of tooth surfaces, before,
during and after periodontal debridement to assess
the progress and completeness of instrumentation.
2. Explorers are used to examine tooth surfaces for

calculus, decalcified and carious lesions, dental
anomalies, and anatomic features such as grooves,
curvatures, or root furcations.

Types Of Calibrated Periodontal Probes
14
 Marquis color-coded probe

 UNC-15 probe
 University of Michigan ‘O’ probe, with Williams
markings
 Michigan ‘O’ probe
 World Health Organization (WHO) probe
 Naber’s Furcation Probe
Calibrated probes have blunt, rod shaped

working ends that may be circular or rectangular in
cross-section.
Marquis Color-Coded Probe
15
 Calibrations are in 3mm sections, markings are

3,6,9,12mm.

The UNC-15 Probe
16
• 15mm long and markings are at each mm and

coding at the 5th,10th and 15thmm.
• Millimeter markings at
1,2,3,4,5,6,7,8,9,10,11,12,13,14 and 15 millimeters.

The University Of Michigan ‘O’ Probe With Williams Markings
17
 Markings include 1,2,3,5,7,8 and 9mm with 4mm and

6mm missing.

Michigan ‘O’ Probe
18
 Markings are at 3, 6, and 8mm.

WHO Probe
19
 Prescribed in 1978.
 The probe was designed for two purposes:
-Measurement of pocket depth.
-Detection of sub gingival calculus.
 Used in the assessment of CPITN (Community
Periodontal Index for Treatment Needs)
 Weight = 5 gm.

WHO Probe
20

WHO Probe
21
 Two variants of WHO Probes are available:

 CPITN-E Probe (Epidemiological Probe)
Markings at 3.5 and 5.5mm.
 CPITN-C Probe(Clinical Probe)
Markings at 3.5, 5.5, 8.5 and
11.5mm.
These additional lines may be of use when
performing a detailed assessment and recording
of deep pockets for the purpose of preparing
treatment plan for complex periodontal therapy.

Naber’s Furcation Probe
22
 It is used to determine the extent of furcation

involvement on a multi rooted teeth.
 It has a curved working end for accessing the
furcation area.
 The end is blunt so that it will not harm soft
tissues.
 Most of the nabers probe do not have markings.
 The depth of insertion of the probe into the
furcation area determines the degree of furcation
involvement.

Naber’s Furcation Probe
23

Probing Technique
24
 The probe should be inserted parallel to the vertical
axis of the tooth and “walked” circumferentially
around each tooth to detect the areas of deepest
penetration.
 To detect an interdental crater the probe should be
placed obliquely from both the facial and the lingual
surface to explore the deepest point of the pocket
located beneath the contact point.
 To detect furcation involvement in multi-rooted teeth,
use of specially designed Naber’s probe allows an
easier and more accurate exploration of the
horizontal component of furcation lesion.
Probing Technique
25

Probing Technique
26
penetration.
Probing Technique
27

Probing Technique
28
penetration.
Probing Technique
29

When to probe
30
 Probing of pockets is done at various times for

diagnosis and for monitoring the course of treatment
and maintenance.
 Initial probing: Done to determine whether the tooth
can be saved or should be extracted.
 Second probing: Done to establish accurately the
level of attachment and degree of involvement of
roots and furcations.

Pocket Probing
31
 There are two different pocket depths:

- The biologic depth is the distance between the
gingival margin and the base of the pocket (coronal
end of junctional epithelium). This can be measured
only by histological sections.
- The probing depth is the distance to which the
probe penetrates into the pocket.

Pocket Probing
32

Pocket Probing
33
 Factors affecting probe penetration:

- Force of introduction.
- The shape and size of the probe tip.
- Degree of tissue inflammation.
- Angle of insertion of probe.
 The depth of penetration of the probe in the
connective tissue apical to the junctional epithelium
in a periodontal pocket is about 0.3mm.
 The probing forces of 0.75N have been found to be
well tolerated and accurate.

Thermal Probe
34
 Thermal probes are sensitive diagnostic devices

used for measuring early inflammatory changes in
the gingival tissues.
 One of the commercially available system, the
PerioTemp Probe enables the calculation of
temperature differential (DT, with a sensitivity of
0.1o C) between the pocket probed and its sub
gingival temperature.
 This temperature differential is useful because it
allows consideration of differences in core
temperature between individuals.

Thermal Probe
35

Thermal Probe
36
 Sub gingival temperature at diseased sites is

increased compared with healthy sites.
 There always exists a natural antero - posterior
temperature gradient existing within the dental
arches.
 Mandibular sites were reported to be warmer than
the maxillary sites.
 Temperature increases with probing depth due to
increase in cellular and molecular activity caused by
increased periodontal inflammation with increasing
probing depth.
Pressure Sensitive Probe
37
 To overcome the limitations of conventional probing

system, pressure-sensitive probes are developed
which have standardized, controlled insertion
pressure.
 With forces up to 30 g, the tip of the probe seems to
remain within the junctional epithelium, and the
forces up to 50 g are necessary to diagnose
periodontal osseous defects.

Pressure Sensitive Probe
38

National Institute Of Dental and Craniofacial Research
(NIDCR)
39
 NIDCR workshop underwent quantitative evaluation

of periodontal diseases by physical measurement
techniques.
 Also, computerization offers the entire dental team

the ideal potential to achieve examiner
standardization, so that future comparison of health
and disease becomes simpler and more precise and
remains cost-effective.

National Institute Of Dental and Craniofacial Research
(NIDCR) criteria for overcoming Conventional Probing
40
LIMITATION CONVENTIONAL NIDCR - CRITERIA

PROBING
Precision 1 mm 0.1 mm
Range 12 mm 10 mm
Probing Force Non standardized Constant and
Standardized
Applicability Non invasive and easy to Non invasive, lightweight
use and easy to use
Reach Easy to access any Easy to access any
location around all teeth location around all teeth
Angulation Subjective A guidance system to
ensure proper angulation
Security Easily sterilized Complete sterilization of
all portions entering the
mouth
Florida Probing System
41
 The Florida Probing System was developed using

the NIDCR criteria.
 This automated probe system consists of probe
hand piece, digital readout, foot switch, computer
interface and computer.
 The end of the probe tip is 0.4mm in diameter which
reciprocates through a sleeve, and the edge of the
sleeve provides a reference by which measurements
are made.

42

43
Handpiece for assessing Handpiece for assessing

probing pocket depths relative clinical attachment
levels

44
Measuring device inserted Probing unit

in sulcus
45
 These measurements are made electronically and

transferred automatically to the computer when the
foot switch is pressed.
 Constant probing force is provided by coil springs
inside the probe hand-piece and digital readout.
 Advantages:
- Precise electronic measurements
- Computer storage of data
- Constant probing force

46
 Disadvantages:
- Lack tactile sensitivity.
- Underestimation of deep probing depths by the
automated probe.

Florida Probing System in determination of
Clinical Attachment Levels (CAL)
47
 The assessment of clinical attachment levels (CAL)

provides information relating to the gain or loss of
connective tissue attachment to the root surface,
and it is the most practical method of determining
that the disease is progressive (active) when a
significant loss of attachment has occurred over
time.
 CAL should be measured ideally from the base of
the pocket to the cemento-enamel junction (CEJ),
the detection of this anatomic landmark is usually
difficult and not easily reproducible by standard
probing methods.
Florida Probing System in determination of
Clinical Attachment Levels (CAL)
48
 The Florida Probe System provides a means of

recording relative CAL changes over time.
 When using Florida Probe, CALs are recorded
relative to a fixed reference point, such as the
occlusal surfaces of the teeth (disk probe) or a pre-
fabricated stent (stent probe).
 These measurements are made sequentially over
time and thus differences in relative attachment
levels at consecutive examinations must be
calculated.

Periimplant Probing
49
 The results obtained with periimplant probing cannot

be interpreted same as the natural teeth because:
- Differences in the surrounding tissues that support
implanted teeth.
- Probe inserts and penetrates differently.
- Around natural teeth, the periodontal probe is
resisted by the insertion of supra-crestal connective
tissue fibers into the cementum of root surface.
There is no equivalent fiber attachment around
implants.

Periimplant Probing
50
 Advantages:
- Can measure the level of mucosal margin relative
to a fixed position on the implant.
- Measure the depth of tissue around the implant.
-Periimplant probing depth is often a measure of the
thickness of surrounding connective tissue and
correlates most consistently with the with the level of
surrounding bone.
 The probing depth around implants presumed to be
“healthy” has been about 3mm around all surfaces.

Conclusion
51
• The “Gold Standard” for recording changes in

periodontal status is longitudinal measurement of
clinical attachment levels from the cemento-enamel
junction or relative attachment level from a fixed
reference point.
• Thus, periodontal probe still remains as a standard

and a conventional diagnostic tool inspite of newer
diagnostic modalities available currently.

References
52
 Carranza’s Clinical Periodontology – 10th edition by

Newmann, Takei, Klokkevold and Carranza.
 Fundamentals of Periodontal Instrumentation &

Advanced Root Preparation – 6th edition by Jill S.
Nield-Gehrig.
 History of Periodontology.

THANK YOU
Periodontal Probes 53 18/03/2010

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PERIODONTAL PROBES

Periodontal Probes 18/03/2010

 Periodontal probes are used to locate, measure, and

 Periodontal probes are used to measure the depth of

Periodontal Probes 18/03/2010

 The third edition of G.V.Black’s Special Dental

Periodontal Probes 18/03/2010

 Simoton refers the periodontal probe as a

 Acceptance of routine periodontal probing in

Periodontal Probes 18/03/2010

•The typical probe is a tapered, rod-like instrument

Periodontal Probes 18/03/2010

 Periodontal probes may be divided into:

Periodontal Probes 18/03/2010

 Third generation probes are computerized

Periodontal Probes 18/03/2010

There are three types of periodontal

Periodontal Probes 18/03/2010

An explorer is an assessment instrument

Assessment instruments like periodontal

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

2. Explorers are used to examine tooth surfaces for

Periodontal Probes 18/03/2010

 Marquis color-coded probe

Calibrated probes have blunt, rod shaped

 Calibrations are in 3mm sections, markings are

Periodontal Probes 18/03/2010

• 15mm long and markings are at each mm and

Periodontal Probes 18/03/2010

 Markings include 1,2,3,5,7,8 and 9mm with 4mm and

Periodontal Probes 18/03/2010

 Markings are at 3, 6, and 8mm.

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

 Two variants of WHO Probes are available:

Periodontal Probes 18/03/2010

 It is used to determine the extent of furcation

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

 Probing of pockets is done at various times for

Periodontal Probes 18/03/2010

 There are two different pocket depths:

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

 Factors affecting probe penetration:

Periodontal Probes 18/03/2010

 Thermal probes are sensitive diagnostic devices

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

 Sub gingival temperature at diseased sites is

 To overcome the limitations of conventional probing

Periodontal Probes 18/03/2010

Periodontal Probes 18/03/2010

 NIDCR workshop underwent quantitative evaluation

 Also, computerization offers the entire dental team

Periodontal Probes 18/03/2010

LIMITATION CONVENTIONAL NIDCR - CRITERIA

 The Florida Probing System was developed using