8 - Disease Activity

Question 1

What are some of the different probe designs used?

Answer 1

Florida probe - measured 0.2mm at 25gm. Stiff metal

Florida disc probe - frisbee on top that hit on occlusal surface and then probe to base of pocket

Alabama Jeffcoat probe - could feel CEJ subgingival, measures 0.1mm changes

Question 2

What determines penetration of probe into sulcus?

Answer 2

Probe thickness
Force
Tooth contours
Degree of inflammation
Loss of CT

Question 3

Does the probe penetrate into the CT?

Answer 3

Caton - not with 25gm. There was increased probe depth with visible inflammation

Fowler - Yes, with 50gm in untreated ChP the probe will penetrate 0.45mm beyond the JE. In health, the probe tip stops 0.73mm coronal to the base of the JE

Question 4

What leads to probe depth reduction after treatment?

Answer 4

Decreased tissue penetration that is secondary to a reduction in inflammation, new collagen production, or long JE

Question 5

Does it matter the location or angulation of the probe?

Answer 5

Persson - line angle vs interproximal leads to underestimating by 1mm. Line angle more reproducible

Ziegler and Allen - 25 degree angle from the long axis, 0.5mm discrepancy

Question 6

What effect does probe tip diameter have?

Answer 6

Pressure = force/area squared

Double force = 2x pressure
Double diameter = 1/4x pressure

Wider probe, less penetration

UNC probe is 0.4mm

Question 7

Where does a probe go in furcations?

Answer 7

Moriarty

In untreated facial molar furcations, the probe penetrates CT and does not record the true PD/CAL

Question 8

In a maintenance population, is a conventional or force-controlled probe better?

Answer 8

Wang

PD/CAL measurements are more reproducible with:
PD <3mm
Maxillary
Anterior
Manual

Question 9

How reproducible are PD/CAL measurements?

Answer 9

Badersten

90% within 1mm
Reproducibility increases with treatment, anterior, incisors, and shallow PD

Question 10

How accurate is bone sounding?

Answer 10

Ursell

At 30g, R value 0.98 with average distance of 0.3mm

Question 11

How does probing force affect CAL gain measurements?

Answer 11

Mombelli

A higher probing force is more reproducible

A lower probing force allows better detection of small changes BUT may underestimate CAL gain because it only measures tissue shrinkage

Question 12

“The harder you probe the…”

Answer 12

Deeper it goes. By 2X for each 1N/cm2 increase in force

Larsen SR

Question 13

What is the histology in a BOP vs non-BOP site?

Answer 13

Davenport

BOP - plasma cells, infiltrated CT, proliferation of rete pegs/PE/JE, widened intercellular spaces, tortuous extensions of rete pegs into CT

Question 14

Does a decrease in BOP mean a decrease in % ICT?

Answer 14

Caton

YES - with an interproximal gingival biopsy 4 weeks after NST there is significant CT repair and an increase in fibroblasts, collagen, and endothelial cells

Question 15

What is Lindhe’s loser site?

Where/when/who does it occur most?

Answer 15

CAL loss >2mm

It occurs most in older people, IP, molar, and with initial advanced LOA

These loser sites occur in a small % of people. 12% of subjects had 70% of loser sites

Question 16

What effect does disease threshold have on PPV?

Answer 16

Increase threshold rom 1 site to 2 sites losing >2mm attachment

PPV goes up and false positives goes down

Question 17

Fastest way to increase PPV of “loser” sites?

Answer 17

Increase the prevalence of loser sites

Question 18

How does most ChP disease progress?

Answer 18

Jeffcoat

Using the Alabama probe, disease activity was defined as 0.4mm

The majority have a linear pattern (76%)

12% with a burst
12% with exacerbation and remission

Question 19

What markers/microbes are higher at “active” sites?

What is the definition of an active site in this study?

Answer 19

Silva

Active site: 2mm or more of CAL over 2 months

PG, anaerobes, RANKL, IL-1B, MMP-13, and CD4/8/19 greater at active sites

Question 20

What happens to systemic markers with ChP treatment?

Answer 20

Ling

Decrease in superoxide release when stimulated by PG/FN

Lower CRP post-treatment as well

Question 21

What puts patients at increased risk for disease progression? Is the lamina dura protective?

Answer 21

Rams

After 30 months, PD 5mm or greater and vertical defects have an OR of 10 and 4, respectively

Radiographic crestal lamina dura might be good indicator of clinical stability

Question 22

Is the IL-1 polymorphism predictive for ChP?

Answer 22

Diehl

NO evidence for association of IL-1 PST test w/ risk of undergoing tooth extraction

Question 23

Is 2 dental visits a year helpful?

Answer 23

Diehl

YES, 2 visits versus 1 associated with reducing the odds the patient has 1 or more tooth extractions over 16 years by 25%

Question 24

What puts a patient at risk for BOP?

Answer 24

Farina

Deeper PD: 3mm 18% BOP, 5mm 46% BOP
Interproximal
Posterior

Deeper the PD, more likely to have BOP

Question 25

Does BOP predict ChP progression in a maintenance population?

Answer 25

Lang

If a site bleeds 4/4 times during maintenance, there is a 70% chance of no attachment loss

Continuous absence of BOP is a reliable indicator for the maintenance of periodontal health. Presence of BOP is not a good indicator of disease progression

Question 26

Does increased probing force increase BOP?

Answer 26

Lang

YES - strong BOP between BOP% and probing force

Linear increase of 11% per 0.25N increment

Question 27

Do implants have BOP more easily? What is the recommended probing pressure?

Answer 27

Gerber

At 0.25N, more BOP at implant vs natural.

With 0.15N/0.25N, PD consistently deeper at peri-implant sites

Question 28

Is there a relationship between CAL and BOP, suppuration, or plaque?

Answer 28

Kaldahl

Sx + maintenance population

BOP and plaque are not prognostic for CAL

Suppuration is a weak prognosticator for CAL

Question 29

What are predictors for CAL?

Answer 29

Claffey

BOP >75% and >1mm PD increase = 87%

1mm or more PD increase = 68%