Florida探针与普通牙周探针测量牙周袋深度的比较

目的比较Florida探针与普通牙周探针测量牙周袋深度(probingdepth ,PD) 的重复性。方法对5例慢性牙周炎患者在牙周基础治疗前后,分别使用Florida探针与普通牙周探针重复测量PD值各两次。分别比较两种探针在治疗前/后测量PD值的重复性,并同一种探针在治疗前后测量PD值的重复性。结果在牙周基础治疗前后,两种探针测量的PD值重复性均良好(P >0 .0 5 ,相关系数范围为0 .77～0 .85 )。对治疗前患者两种探针重复性相近,而对治疗后患者Florida探针的重复性好于普通牙周探针(P <0 .0 5 )。结论Florida探针测量PD值的重复性良好,能可靠地应用于牙周临床研究。     

Accuracy and reproducibility of probe forces during simulated periodontal pocket depth measurements

AimThe aim of the present study was to measure the accuracy and reproducibility of probe forces in simulated assessments of periodontal pocket depth. The study included experienced and inexperienced examiners and used manual and pressure-sensitive probes.Materials and methodsSixty-one participants were divided into seven groups and asked to probe selected anterior and posterior sites with three different probes (Williams 14W, Chapple UB-CF-15, and Vivacare TPS probes). The model was positioned on a digital electronic balance to measure force, which was recorded initially and after 15 min. Probe preferences were recorded. Accuracy was measured by comparing to a standardized 25 g force, and reproducibility was calculated for all duplicate measurements.ResultsThe Vivacare probe produced the most accurate and most reproducible forces, whereas the Williams probe produced the least accurate and least reproducible forces. Probe forces were lighter at anterior sites compared to posterior sites at baseline. Probe forces were reduced at both sites after 15 min compared to baseline.ConclusionsVivacare TPS periodontal probes are more accurate and reproducible than Chapple and Williams probes. Many clinicians in this study preferred the Chapple probe.     

Histological evaluation of probing depth following periodontal treatment

Abstract The aim of this study was to compare the periodontal probing depth in teeth exposed to pariodontal treatment with teeth having received no treatment. In pockets deeper than 4 mm, a significant difference was found between the two groups. In the non-treated teeth, metal strips used for probing penetrated an average of 0.29 mm into the connective tissue apical to the junctional epithelium. The average probing depth for teeth exposed to scaling, root planing, curettage and chlorhexidine rinses for 1 month was 0.31 mm coronal of the connective tissue attachment within the junctional epithelium. The results indicate that care should be taken when evaluating changes in periodental probing measurements during longitudinal studies.     

The influence of probing force on the reproducibility of pocket depth measurements

Abstract Seven patients were selected on the basis of having about 50% loss of alveolar bone support in some part of the mouth. All patients received initial treatment consisting of plaque control and removal of subgingival deposits. In these patients, 102 interproximal pockets were measured by three different examiners, both with the pressure probe and a Merritt – B probe (Hu – Friedy®). No specific instructions were given as to how the interproximal regions should be probed. Results indicate that a standardized probing force of 0.75 N does not lead to more reproducible pocket depth measurements.     

Non-Gaussian distribution of differences between duplicate probing depth measurements

The present study aims to determine the accuracy and the distribution of the error of probing depth measurements. Duplicate measurements were performed at 1069 sites in 13 subjects. Measurements in shallow pockets (less than or equal to 3 mm) were significantly (p less than 0.001) more reproducible than measurements in deep pockets (greater than 3 mm). The overall standard deviation of the measurements was 0.74 mm. Differences between duplicate measurements were not normally distributed. Differences of 2 mm or more were recorded more frequently than one would expect on basis of the standard deviation and a hypothetical normal distribution. The observed frequency of large differences (greater than or equal to 3 mm) is much higher than the theoretical change as suggested in the literature that such differences may occur as a result of the inaccurate probing measurements. This finding implies consequences for the chance of making false claims that true changes in probing depth and attachment level have occurred over time, if the claims are based on the standard deviation and the wrong assumption that the error of the measurement is normally distributed.     

口腔医学本科实习医师牙周探诊检查的准确性及影响因素分析

目的 评估口腔医学本科实习医师牙周邻面探诊的准确性并分析可能的影响因素,以期为牙周临床教学提供参考.方法 按照临床带教常规,选取北京大学口腔医学院38名初次进入牙周临床实习的本科生,每名实习医师均使用Williams刻度探针检查并记录1～2例(共58例)慢性牙周炎患者的探诊深度,教师进行重复探诊并加以核对,记录Ramfjord代表牙(6|14/41|6)邻面探诊深度的复核结果作为本项研究的结果数据.根据实习医师与教师探诊深度的差异,将所有位点分为完全一致位点(实习医师与教师探诊深度相同的位点)、基本一致位点(实习医师与教师探诊深度差异为1 mm的位点)和不一致位点(实习医师与教师探诊深度差异≥2 mm的位点).结果 随着牙周袋加深,学生的探诊准确性下降.完全一致位点百分比磨牙[58.8％ (261/444)]显著低于切牙[73.1％(339/464)],P＜0.01.实习医师邻面探诊不准确的最主要原因是不能探入龈谷,此项因素占70.7％ (87/123).结论 邻面探诊角度的培训应成为牙周临床前期探诊教学的重点,临床实习时教师需重点核查实习医师对深牙周袋和磨牙的邻面探诊.     

The role of periodontal probing depth in clinical decision-making

This retrospective study examines the role of periodontal probing depth in clinical decision-making. The expected values of no treatment and surgical and non-surgical therapies were obtained by combining the probability of each treatment outcome and utility values denoting the preference for each outcome. The expected value for non-surgical therapy was higher for sextants exhibiting a positive response to initial therapy than sextants which did not respond to initial therapy (0.735 versus 0.706). This trend was not observed for sextants treated surgically. Surgical therapy was effective over all levels of disease severity and was the preferred form of therapy with respect to reduction of probing depth except for sextants exhibiting 4 to 5 mm pockets. In this latter situation, the expected value at 3 years for non-surgical and surgical therapy was 0.795 and 0.792, respectively. Neither form of therapy could consistently achieve periodontal probing depths equal to or less than 3 mm throughout a given sextant. This study facilitates the selection of an optimal therapeutic strategy with respect to periodontal probing depth.     

Effect of probing depth and bleeding tendency on the reproducibility of probing depth measurements

The aim of this study was to determine the influence of the probing depth and the bleeding tendency on the reproducibility of probing depth measurements. Duplicate probing depth and bleeding tendency measurements were performed at 717 interproximal sites in 13 subjects. Analysis indicated that the factor probing depth had a larger effect on the accuracy of probing depth measurements than the factor bleeding tendency.     

Comparative reproducibility of proximal probing depth using electronic pressure-controlled and hand probing

Abstract This investigation assessed the effect of an electronic pressure-sensitive probe on the reproducibility of probing-depth measurement. Clinical measurements were made at the mesial and distal aspects of all teeth from the buccal and palatal or lingual aspects. Probing was carried out either in a conventional manner using gentle pressure referred to as hand probing or using an electronic pressure-sensitive probe set at 25 g and referred to as pressure-controlled probing. Probing-depth recordings were repeated for one randomly selected quadrant in each subject with random application of the 4 different combinations of pressure-controlled and hand probing. A total of 2584 replicate pairs of probing depth measurements were recorded on 4 proximal surfaces in 646 teeth in 100 adult subjects. The majority (98%) of all repeated measurements were within 1 mm of the initial values. The highest levels of agreement resulted when the same probing method was used at both examinations with electronic pressure-controlled probing being superior to hand probing regardless of tooth position or site. Duplicate measurements recorded with combinations of hand and pressure-controlled probing showed significant systematic bias towards shallower pocket depths with electronic pressure-controlled probing.     

对新一代Florida探针临床测量可重复性和舒适度的评价

目的：评价新一代Florida探针测量牙周袋深度的可重复性和舒适度。方法在基础治疗后3个月维护期内,选择35例牙周炎患者为研究对象,2位检查者先后使用普通探针与Florida探针重复测量每个位点的探诊深度各2次,分别比较2种探针测量牙周袋探诊深度的可重复性,及2位检查者使用同1种探针测量牙周袋探诊深度的可重复性。应用视觉模拟评分法,比较患者接受2种探针检查时的舒适度。结果新一代Florida探针与普通牙周探针测量的牙周袋探诊深度重复性均良好（P>0.05）,浅袋和中袋的可重复性比深袋更好（P<0.05）。但在不同测量者之间Florida探针可重复性略优于普通牙周探针（P<0.05）,且比使用普通牙周探针让患者感觉更舒适（P<0.05）。结论新一代Florida探针可可靠的在慢性牙周炎维护期患者的临床研究中使用。     

Contemporary concepts in the diagnosis of periodontal disease

Periodontitis is an inflammatory disease of bacterial origin that results in the progressive destruction of the tissues that support the teeth, specifically the gingiva, periodontal ligament, and alveolar bone. The diagnosis of periodontal disease currently relies almost exclusively on clinical parameters and traditional dental radiography. In this article, the authors review current diagnostic techniques and present new approaches and technologies that are being developed to improve assessment of this common condition.     

Depth-force-patterns in periodontal probing

This investigation was undertaken to study penetration-depth and simultaneous force development during the insertion of a standard periodontal probe tip into a pocket to gain information about the tissue resistance to probing and its relation to the accuracy of depth determination. A piezoelectric force transducer and a linear position transducer were incorporated into a periodontal probe. Depth-force diagrams were obtained on an x-y plotter. In 5 patients requiring treatment for chronic periodontitis, 50 sites were selected and measured 3 times before and 3 times after a treatment phase consisting of hygiene instruction, systematic deep scaling and root planing. The minimal required probing force for reproducible values within a limit of 0.5 mm up to a force of 1.2 N was determined for each record ("b-value") and correlated in a multiple linear regression analysis with a number of clinical parameters of the sites. Depth-force diagrams recorded with the probe showed the characteristics of saturation curves flattening off in the range of 1 N and more. When the probing force was increased from 0.41 N up to 1.2 N, 50% of all measurements showed an increase in depth of more than 0.5 mm. However, increasing from 0.9 to 1.2 N resulted in a change of more than 0.5 mm in only 5% of the measurements. Differences in b-values before and after the treatment were significant (p less than 0.01). Differences related to tooth type (M, PM, I) and conventional pocket depth before treatment were also significant (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Significance of probing force for evaluation of healing following periodontal therapy

The present report compares pre- and postoperative probing pocket depths and probing attachment levels in deep pockets treated non-surgically as well as surgically using probing forces at 0.25 N, 0.50 N and 0.75 N. The results demonstrated that the recorded mean pre- and postoperative probing depths were deeper with increasing probing force. In deep preoperative pockets, the difference amounted to as much as 2.0 mm comparing measurements at 0.25 N and 0.75 N. The use of 0.25 N for evaluation of therapy showed less mean pocket reduction and probing attachment gain than the use of 0.50 N or 0.75 N. Selection of a higher probing force before therapy (i.e. 0.75 N) and a lower force after therapy (i.e. 0.25 N) resulted in increased values for pocket reduction and probing attachment gain compared to use of the same probing force for both pre- and postoperative recordings. The findings emphasize the significance of using a known and standardized probing force for evaluation of results following periodontal therapy.     

Probe tine diameter and probing depth

The aim of this study was to assess the effect of difference in tine diameter on probing pocket depth measurement. 2 sets of tines with Williams markings at 1, 2, 3, 5, 7, 8, 9 and 10 mm, and with a "round" tip, diameter 0.5 mm, were compared. One set was described as parallel-sided, the other as tapered. The parallel-sided tine was almost parallel from the 10 mm marking to the tip (tip diameter mean = 0.46 mm, 95% C.I. 0.456-0.464), while the corresponding diameter for the tapered tine varied (tip diameter mean = 0.48 mm, 95% C.I. 0.473-0.489). Calibration markings appeared highly consistent with the expected value to within 0.01 mm. The tines were mounted in Brodontic handles at 0.25 N. Examiner probing repeatability yielded kappa 0.86 for "parallel-sided" and 0.81 for "tapered" tines in vivo. 412 approximal pockets were assessed in 53 patients with routine chronic adult periodontitis, mean age 42.1 years. Each site had a probing depth of greater than or equal to 5 mm, PlI less than or equal to 1, GI less than or equal to 1, PBI less than or equal to 1. Each site was probed 2x with a 15-min interval. At the first 251 sites, the parallel-sided tine was used initially, and the tapered at the remaining 161 sites. Results indicated a highly significant tendency for the parallel-sided tine to yield a deeper reading when a difference occurred. These findings indicate that with adequate training providing high examiner repeatability, one source of error in probing data can be minimised.     

Bleeding on probing and probing depth as indicators of the response to plaque control and root debridement

19 adult periodontitis patients were treated with plaque control and a single episode of root debridement. Results of this treatment were monitored in non-molar sites, molar flat surface sites, and molar furcation sites by probing attachment level measurements every 3rd month for 24 months. After 24 months, sites with probing attachment loss were identified using linear regression analysis. Clinical scores for supragingival plaque, bleeding on probing, suppuration on probing, and probing depth, obtained from these sites during the 24-month study, were analyzed to determine if they could be used diagnostically as indicators of probing attachment loss. The results demonstrated that the diagnostic accuracy for these clinical indicators was generally low at all 3 anatomical site locations. A possible explanation for this limited diagnostic accuracy may be that some areas of probing attachment loss following basic periodontal therapy are caused by factors other than the progression of an inflammatory periodontal disease of microbial etiology.     

Influence of probing force on the reproducibility of bleeding tendency measurements

Abstract Three groups of seven patients were selected on the basis of about 50 % loss of alveolar bone support in some part of the mouth. All patients received initial treatment consisting of plaque control and removal of subgingival deposits. In the first group of patients 95 interproximal pockets were measured three times by one examiner using the pressure probe employing a constant probing force of 0.75 N. Bleeding or lack of bleeding from a pocket was sought for up to 30 seconds after probing. Results show that a time interval of 15 minutes between reexamination procedures is enough to prevent an increased bleeding index caused by repeated probing. In the second group of patients, 98 interproximal pockets were measured three times with a Merritt-B probe (Hu-Friedy®), each time by a different examiner. In the third group of patients, 102 interproximal pockets were measured three times with a pressure probe, each time by a different examiner. The same three examiners were involved. In both groups presence or absence of bleeding from a pocket was recorded. Results show a proportion of inter-examiner agreement among three examiners of 0.40 with the Merritt-B probe and 0.71 with the pressure probe. It is concluded that a constant probing force of 0.75 N does contribute to more reproducible bleeding tendency measurements.     

Manual and electronic probing of the periodontal attachment level in untreated periodontitis: a systematic review

OBJECTIVE: A systematic review of clinical trials has been performed to evaluate the reproducibility of manual (MP) and electronic probes (EP) in the measurement of clinical periodontal attachment level (AL) in untreated periodontitis subjects. METHODS: Systematic electronic (PubMed Medline and Latin American and Caribbean Health Science--LILACS literature databases) and hand searches (English, Spanish and Portuguese languages; search terms "periodontitis diagnosis", "clinical attachment level measurements", "clinical attachment level detection", "clinical diagnosis of periodontitis", "manual probe", "electronic probe", "periodontitis or periodontal disease or attachment level or clinical attachment level") were performed to identify clinical trials involving CAL measurements, MP and EP in untreated periodontitis subjects. Quality and external validity were determined for selected studies. RESULTS: The initial search identified 37 articles. Ten studies met the initial eligibility, but eight were excluded after thorough analysis. The results from those two selected studies showed that the average variance and the absolute mean difference of CAL measurements for both types of probes cannot be considered different. CONCLUSION: "Based on this systematic review, MP and EP probes showed a tendency to have similar reliability in the measurement of CAL in untreated periodontitis subjects when used by a calibrated examiner. However, this finding is not supported by strong evidence.     

Sources of error for periodontal probing measurements

This study determined the relative contribution to probing measurement reliability of several factors, compared with that of random error. Probing measurements were performed by examiners properly trained and calibrated. A total of 5771 pairs of replicate pocket depth (PD) and relative attachment level (RAL) measurements were performed with the Florida Probe®. A total of 1488 replicate clinical attachment level (CAL) measurements were performed with the North Carolina 15 mm probe. In addition, longitudinal replicate measurements of RAL were performed at 0 and 12 months on 816 sites in 11 patients utilizing the Florida Probe® 20 mm disk probe. Measurement reliability with the Florida Probe® resulted in mean intraexaminer variances of 0.21 and 0.33, for PD and RAL, respectively (s.e.m. 0.46 mm for PD and 0.57 mm for RAL). Measurement reliability with the conventional probe resulted in mean intra-examiner variances of 0.19 for PD and 0.32 for CAL (s.e.m. 0.44 mm and 0.56 mm). Pocket depth contributed to =5% of the variability of the intra-examiner variance with both probes with other contributing factors being the individual patient, tooth and site location. Mean intra-examiner reproducibility for duplicate RAL measurement performed at 0 and 12 months was 0.24 and 0.19, respectively (s.e.m. 0.49 mm and 0.43 mm). In conclusion, a mean intra-examiner variance of ≤0.24 can be achieved for replicate measurements with both electronic and conventional probes for moderate and severe periodontitis patients. Individual examiner, individual patient and site location contribute up to 10% to the overall variance. Hence, the pattern of variability for intra-examiner variance of probing measurements performed with either electronic or conventional probes by trained and calibrated examiners is mostly random error.