Periodontal Indices and Dental Imaging

1. Milan Chande

2. GINGIVITIS: an inflammatory lesion mediated by
host/parasite interaction that remains localised to
the gingival tissues and does not extend to involve
the pdl, cementum and alveolar bone
 PERIODONTITIS: an inflammatory lesion
mediated by host/parasite interaction that results
in loss of connective tissue attachment to the root
surface and ultimately to alveolar bone loss
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3. Gingival Colour
 Gingival Texture
 BOP (Bleeding on Probing)
 Mobility
 Presence of Plaque
 Presence of Calculus
 Pocket Depth
 Recession
 Presence of Plaque Retention Factors
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This is a screen to see if a patient is periodontally
healthy or diseased.
Quick and easy to perform
If an Initial score of 3 or higher, a DPC is necessary
Mouth split into 6 sextants: 7-4 | 3-3 | 4-7
Probing force of 20-25g used
All teeth examined but 8s are not generally included
unless the 7 is missing
Worse score in each sextant is recorded
Where no tooth exists in a sextant x/ - is given
If only 1 tooth in to sextant, the single tooth is
incorporated into the adjacent sextant

5. •Termed E type due to the nature in which
it is used.
•Used in Epidemiological analysis to see
whether patient’s have healthy
periodontum or diseased.
•Up to 3mm pocket’s indicate a healthy
periodontum
•Greater than 3mm pocket’s indicate the
possibility of periodontal disease.
•Greater than 5mm indicates periodontal
disease and attachment loss.

6. •Termed C type due to the nature in which it is
used.
•Used in Clinical analysis to see whether patient’s
have healthy periodontum or diseased.
•Up to 3mm pocket’s indicate a healthy
periodontum
•Greater than 3mm pocket’s indicate the possibility
of periodontal disease.
•Greater than 5mm indicates periodontal disease
and attachment loss.
•This probe also has a second black band
indicating pocket depths of greater than 8mm

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Code 0 = No pockets >3.5 mm, no calculus/overhangs, no
bleeding after probing (black band completely visible)
Code 1 = No pockets >3.5 mm, no calculus/overhangs, but
bleeding after probing (black band completely visible)
Code 2 = No pockets >3.5 mm, but supra- or subgingival
calculus/overhangs (black band completely visible)
Code 3 = Probing depth 3.5-5.5 mm (black band partially visible,
indicating pocket of 4-5 mm)
Code 4 = Probing depth >5.5 mm (black band entirely within the
pocket, indicating pocket of 6 mm or more)
Code * = Furcation involvement

8. 
Code 0 =No need for periodontal treatment
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Code 1 = Oral hygiene instruction (OHI)
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Code 2 =2 OHI, removal of plaque retentive factors,
including all supra- and subgingival calculus
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Code 3 =OHI, root surface debridement (RSD)
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Code 4 =OHI, RSD. Assess the need for more complex
treatment; referral to a specialist may be indicated.
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Code * = OHI, RSD. Assess the need for more complex
treatment; referral to a specialist may be indicated.

9. 
In young people aged 7-19 years the false pockets associated
with normal tooth eruption makes it difficult to determine whether a
pocket needs periodontal treatment or not.
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Therefore in patients more than 12 years old probing is restricted
to:
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These permanent teeth, being the first to erupt into the mouth,
would be the least likely to have false pockets yet the most likely
to reveal any true periodontal breakdown.
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BPE scores need to be interpreted carefully

10. Used to measure pocket depths.
 A pocket measuring probe/ Williams probe is
used.
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Main components to record:
- Pocket depth (mm)
- Mobility
- Recession (mm)
- Bleeding on probing
- Furcation

13. Two Blunt Instruments are used to asses a tooth’s
mobility. E.g End of mirror and probe
 To quantify Mobility, Millers index of mobility is used:
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Grade 0 – Normal Physiological mobility (<1mm)
Grade 1 – Movement up to 1mm in horizontal plane
Grade 2 – Movement greater than 1mm in horizontal
plane
Grade 3 – Severe mobility greater than 2mm or vertical
mobility

14. The furcation is the point at which the two roots
divide.
 A pocket measuring probe is used.
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Ramfjord and Ash furcation index:
 Grade 0 – No clinical furcation involved
 Grade 1 – Bone loss up to 1/3 width
 Grade 2 – Bone loss up to 2/3 width
 Grade 3 – Through and through defect

15. •To measure the recession of a
individual tooth, a pocket measuring
probe must be used.
•The probe is placed onto the tooth
and the distance between the
cemento-enamel junction and the
gingival margin is measured. This is
the amount of recession that has
occurred on that tooth.

16. The pocket measuring probe is inserted into the
gingival crevice.
 The distance from the base of the pocket and the
gingival margin is measured.
 In addition, if the site bleeds on probing, circle the
score in red and if the site has suppuration (pus)
circle the score in blue or black.
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The DPC allows the operator to find sites in the mouth
requiring attention.
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Sites with pockets greater than 5mm will require RSD.
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Subsequent Pocket Depths can be measured after
treatment to assess the success of treatment.
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You can work out clinical attachment loss (CAL) using
the date collected:
baseline pocket depth + recession = CAL
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CAL represents the true loss of PDL due to periodontal
disease

18. http://www.bsperio.org.uk/publications/downloads/39_1
 Blackboard Generic Learning Materials >
Periodontology
 2nd Year Perio Booklet.


19. Milan Chande

20. There are a number of different types of imaging
services available to a Dentist.
 Each being beneficial in the diagnosis and overall
care of the patient.
 A few examples include:
• Clinical Photographs
• Radiographs
• Cone Bean Computed Tomography
• Magnetic Resonance Imaging
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Taking such photo’s before, during and after helps both the
Dentist and patient look at all the treatment that has been
carried out on the patient.
The patient will be able to appreciate the amount of work
the Dentist has carried out. They will also be able to see
the difference all the work has had on the health and
appearance of their oral cavity.
The Dentist can use these images to evaluate the work he
has done. He will be able to understand any obstacles that
came across during the procedures undertaken. Thus he
will be able to audit himself and ensure he strives to
improve on his skills for future patients.

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Detection of apical infection/inflammation.
Assessment of the periodontal status.
After trauma to teeth and associated alveolar bone.
Assessment of the presence and position of the
unerupted teeth.
Assessment of root morphology before extractions.
During endodontics.
Preoperative assessment and postoperative appraisal of
apical surgery
Detailed evaluation of apical cysts and other lesions
within the alveolar bone.
Evaluation of implants postoperatively.

23. Radiographs such as these are taken to find
interproximal caries.
 They can also be used to assess Interproximal
Bone Levels.
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Detection of apical infection/inflammation.
Assessment of the periodontal status.
After trauma to teeth and associated alveolar bone.
Assessment of the presence and position of the
unerupted teeth.
Assessment of root morphology before extractions.
During endodontics.
Preoperative assessment and postoperative appraisal of
apical surgery
Detailed evaluation of apical cysts and other lesions
within the alveolar bone.
Evaluation of implants postoperatively.

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Periapical assessment of the upper anterior teeth,
especially children.
Detecting the presence of unerupted canines
supernumeraries and odontomes.
As the midline view, when using the parallax method for
determining the bucco/palatal position of unerupted
canines.
Evaluation of the size and extent of lesions such as
cysts or tumours in the anterior maxilla.
Assessment of fractures of the anterior teeth and
alveolar bone.

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The assessment of the presence or position of
unerupted teeth.
Detection of fractures of the mandible
Evaluation of lesions or conditions affecting the jaws,
including cysts tumours, giant cell lesions and
osteodystrophies.
As an alternative when intraoral views are unobtainable
because of severe gagging or if the patient is unable to
open the mouth or is unconscious.
As a specific view of the salivary glands or TMJ

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As part of an orthodontic assessment where there is a
clinical need to know the state of the dentition and the
presence/absence of teeth.
To assess bony lesions or an unerupted tooth that are
too large to be demonstrated on intraoral films.
Prior to dental surgery under GA
As part of a periodontal assessment of bone support,
where there are pockets greater than 5mm
Assessment of third molars, at a time when
consideration needs to be given to whether they should
be removed

31. Becoming increasingly used in Dentistry in the
fields of Orthodontics, Implantology and
Endodontics.
 It works by producing slices of images of the area
concerned using x-rays.
 These images are divergent, forming a cone.
 Advantages of this technique include it’s ability to
record a high level of detail of bone. Therefore
able to work around bone levels of the patient.
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33. 
Patients are placed into an intense magnetic field.
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This forces their hydrogen nuclei to align in the field. Radio
Waves are then pulsed into the patient, the hydrogen nuclei
‘wobble’, producing an alteration in the magnetic field.
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This induces an electric current in coils placed around the
patient.
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The computer reads this and is able to produce an image of it.
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It is capable of producing any image a CT Scanner can produce,
however this becomes difficult as the cost of MRI scan’s is much
greater than using traditional methods of radiography.

35. Master Dentistry Volume 1
 Blackboard > Dental Radiography Techniques
