Presented by: Mellissa Boyd, RDH, BSDH The Periodontal Probe Presented by: Mellissa Boyd, RDH, BSDH

Calibrated Probe Assessment instrument Determine health of periodontal tissues

Working-End Blunt Rod-shaped Millimeter markings Color coded Cross-section Round Rectangular

Purpose Measurement Sulcus/pocket depths Width of attached gingiva B C Measurement Sulcus/pocket depths Width of attached gingiva Bleeding Exudate Oral lesions Furcations A = alveolar mucosa B = attached gingiva C= mucogingival junction D = GM E = Free gingiva E D

Sulcus vs. Pocket Sulcus Pocket Space between free gingiva and tooth 1-3mm Pocket Sulcus deepened because of disease 4mm+ Gingival vs. periodontal

Probing Depth Entire sulcus probed Six sites per tooth 3 buccal 3 lingual Record deepest reading per site Depth rounded up to nearest mm

Basic Technique Insert tip to JE, feel slight resistance Gentle walking strokes 10 – 20 grams pressure Digital motion Close together 1-2 mm Not out of sulcus

Probe Position ‐ Healthy Tissue Sulcus • Space between free gingiva and tooth • Healthy sulcus = 1 to 3 mm • Probe tip touches tooth near the CEJ

Probe Position – Diseased Tissue Pocket • Sulcus deepened because of disease • 4mm+ • Bleeding • Probe tip touches root at point apical of CEJ

Comparison Measurement Marquis Probe (3‐6‐9‐12) Healthy Sulcus Diseased Pocket Probing Depth? Probing Depth?

Need CPE to get the full story

Measurements Recorded 6 sites per tooth Record deepest reading

Insertion of Probe Tip Keep side of tip against tooth surface Tip = 1-2mm of probe Observe enamel contour near CEJ Tip parallel to tooth surface, keep constant contact with tooth surface

Incorrect Insertion Probe tip should NOT be held away from tooth • Inaccurate measurement • PAIN

Adaptation Parallel to long axis of tooth Inaccurate measurement

Probe Walking Stroke Gently insert to base of sulcus • Walking Stroke – Series of light bobbing strokes – Made within sulcus/pocket while keeping side of probe tip against tooth surface

Maxillary Posterior Technique Extraoral fulcrum Begin at DB line angle of maxillary right most posterior tooth (1, 2, etc) • Insert & walk probe into distal “area” • Record deepest measurement from DB line angle to D of tooth Walk all the way to the direct Distal

Maxillary Posterior Technique Remove and reinsert probe @ DB line angle • Walk probe across B surface • Walk probe around MB line angle and touch M contact • Slant probe under contact (col) • Take measurement under M contact in col area If no contacting tooth, take measurement @ direct distal

Maxillary Anterior Technique NOTE: – When you reach midline, walking sequence will reverse for max L quadrant …starting @ #9 you will walk probe from MF line angle into M – Touch contact and slant probe very slightly to access col reading (anterior teeth are thinner so don’t over tilt) – Remove & reinsert at MF line angle, probe across M around DF line angle (continue sequence for max L quad) – Probe Lingual surfaces from #15, 16, etc. back across arch

Max vs. Mand – who wins?

Mandibular Technique Posterior – Begin at DB line angle of mandibular right most posterior tooth (32, 31, etc) • Anterior – At midline walking sequence will reverse for mand L quadrant starting @ #24 you will walk probe from MF line angle into M – Touch contact and slant probe very slightly to access col reading (anterior teeth are thinner so don’t over tilt) – Remove & reinsert at MF line angle, probe across M around DF line angle (continue sequence for mand L quad) – Probe Lingual surfaces from #17, 18, etc. back across arch

Furcation Involvement Bone loss in area of furcation Result of periodontal disease Furcation probe or periodontal probe Access Mandibular molars Maxillary molars Maxillary 1st premolar

Oral Lesions or Deviations Document with measurement Use anatomical references anterior-posterior (front to back) superior-inferior (top to bottom)

Mucogingival Examination Attached Gingiva Area from base of sulcus to mucogingival junction (MGJ) Attached to the cementum of tooth and alveolar bone by collagenous fibers Attached Gingiva Functions to keep free gingiva from being pulled away from tooth Width varies Widest anterior teeth (3.5-4.5mm maxilla and 3.3-3.9mm mandible) Narrowest on premolar teeth (1.9mm maxillary and 1.8mm mandibular)

Mucogingival Examination Alveolar mucosa located apical to the MGJ deeper red color than attached Shiny and loosely attached to underlying bone MG defect Recession near MGJ or into alveolar mucosa

Clinical Attachment Level Measurement from the CEJ to JE Most accurate measure of attachment loss Three possible relationships: GM apical to CEJ (recession) GM coronal to CEJ (hyperplasia) GM level with CEJ

Accuracy of Measurement Affected by: • Size & design of probe • Technique • Tissue health • Adaptation of probe tip against side of tooth • Walking stroke control • Avoiding excessive pressure • Correct angulation into “col” area

Charting Practice Mandibular right first molar, facial aspect Typodont William’s probe Probe and record Mandibular right first molar, facial aspect (Nield p 233 –235) Mandibular left canine, facial aspect (Nield pp 236-237)