Objectives of the presentation:
1- State the importance of the periodontal probing measurement as the standard method for determining the prevalence, prognosis or resolution of periodontal disease.
2-State the reasons why Whole Mouth Periodontal probing WMB is considered the Gold Standard in comparison to Partial Recording Protocols, such as PRS, Index teeth, Ramfjord teeth, and partial mouth probing.
3- State the 1979 National Institute of Dental and Craniofacial Research NIDCR for ideal periodontal probing measurement protocol.
4- Describe the components system for Computer Assisted Periodontal Probing and Diagnosis
5- Describe the clinical procedures for using CAPPD
6-list the advantages of the CAPPD system
The Problem:
Whole Mouth Probing WMB to determine the measurements of the clinical attachment levels (CAL) and the Periodontal Pocket depth (PD) in the dental patient is considered the Gold Standard periodontal practice and research. WMB requires two individuals. Preferably, the dentist and dental assistant, or the Dental Hygienist and dental assistant for recording the results of manual probing at six different sites of each tooth in the mouth. The clinician must: 1- read the one mm bands on the periodontal hand-held probe.2- Estimate the depth of probe insertion in the gingival sulcus (health) or the periodontal pocket (disease) .3-Call out the measurement numbers to the 4- dental assistant who has to record it in the patient chart.
The WMB test is/and ought to be the standard of periodontal health and disease assessment because of its comprehensiveness, clinical nature, evidence-based support and accuracy. WMB is more accurate than the Partial Recording Protocols PRP that was used to minimize the stress WMB, difficulty (186 measurements), and time consumption. (30 minutes).PRP is controversial and found to underestimate the true prevalence and incidence of periodontal diseases and thus are not recommended in clinical comprehensive patient care. Another significant technical problem of conventional manual probing is the clinician bias factor (habits or tendencies) that lead to the use of variable and inconsistent probing force. The lack of inter-examiner and intra-examiner consistency and the variability of probing forces from 3g to 153 g are well documented. Heavy-handed probing yield "deeper" pockets and it could cause pain and discomfort due to an inadvertent excessive propping force (30-50 gram) that may penetrate the sulcus floor.
Solution:
Computer Aided Periodontal Probing and Diagnosis
In 1979 the National Institute of Dental and Craniofacial Research NIDCR issued a request for proposals to develop and clinically test an improved periodontal pocket depth- attachment level measurement system that must meet the following criteria: 1-A precision of +/- 0.1mm, 2-A range of 10mm, Constant probing force4) Non-invasive, lightweight for comfortable me over an extended period of time and easy to learn to use.5) Able to access any location around all teeth6) A guidance system to ensure the measurement be taken from the same part of the sulcus each time (desirable but not mandatory) 7) Complete sterilization of all portions entering or near the mouth. cold sterilization not acceptable.8) No biohazard from materials or electric shock9) Digital output The computerized periodontal probe is an example of best practice of integrating biotechnology in periodontal probing. All the criteria requested by NIDCR were met. For the past two decades, computerized probing has been verified and supported by Evidence-based research. This presentation will describe the system and focus on the following.
Advantages:
1- the Constant point of reference for probe insertion, the gingival margins as the same constant reference for probe insertion, instead the hidden difficult to locate subgingival Cemento-Enamel Junction (CEJ)
2- Constant - 15-gram probing force predetermined for efficiency and safety and controlled by the computer instead the clinician
3- Computerized automated voice call- out the measurement of the sulcus or pocket depth instead of trying to see, read and calculate the depth by the clinician
4- Once the computerized probe is inserted in the sulcus /pocket to the gingival reference, and the system is activated, the numerical measurement is called out in English, appeared on the system screen, diagnosis sheet and recorded on the periodontal chart. The clinician can also mark other signs and symptoms of the periodontal disease using specially designed color codes, symbols, and drawings.
5- Standardization of the probing force, (15g) and an accuracy (0.1mm), make it possible for only one examiner to use the system. No longer necessary to have an assistant to record the numbers manually. Dental hygienists are most qualified to collect the data and have it ready for the clinician to determine the diagnosis efficiently and accurately.
6-New Dental appointment experience. The high- tech examination environment makes possible to educate, motivate and enhance the patient acceptance and compliance with the proposed treatment. With the increased awareness of the patients, they will understand, Periodontal disease high prevalence, its role in tooth loss, and association with cardiovascular disease, diabetes, stroke, respiratory disease.
Periodontal Disease remains seriously undetected, undiagnosed and even untreated for two reasons, the first: Dentists do not look for it like they do with dental caries. The second: periodontal disease in all of its classification, light, moderate, severe, or aggressive is asymptomatic.
Patients do not seek periodontal treatment because they know dentistry only thru a toothache or/and aesthetics model. Full mouth probing is seriously neglected in general dental offices except those who have dental hygiene or periodontal care. The use of computerized assisted periodontal probing and diagnosis CAPP in general dental practice will change the patient attitude toward their oral/periodontal health.
The patient will benefit greatly when going thru the experience of CAD periodontal probing system. They become more involved in the examination of their mouth and teeth. Especially when they listen to the voice call-out and the verbal warning of deep pockets, bleeding, suppuration, etc. and also see these data on the screen and late in their take-home diagnosis sheet, they become more aware, involved and interested in their oral health and treatment.
