Mobility and percussion sound of healthy upper incisors and canines

Abstract In order to evaluate the correlation between mobility and percussion sound, 126 upper incisors and canines in 21 student volunteers were measured by means of the Periotest (Siemens), by evaluating the percussion sound subjectively and by analyzing its spectrum. The attenuation time and frequency of the sound were measured for each tooth, A logical mobility and percussion sound existed in accordance with the sizes of the teeth. Spearman correlation coefficients close to 1.00 were noted in individual cases between the Periotest and the three other tests describing the percussion sounds.     

Periotest for measuring periodontal characteristics–Correlation with periodontal bone loss

The Periotest measures the reaction of the periodontium to a defined percussive force. The percussion is applied to the tooth by an electronically controlled tapping head. Information on structural change is obtained by measurement of both the elastic and viscous characteristics of the periodontium. The latter prevent oscillations of the tooth in the alveolar bone. A value is calculated and is displayed as a "Periotest value". The following research report shows the relation of Periotest values to bone loss. Bone loss was quantitatively determined for 2312 teeth from orthopantomographic radiographs and for 900 teeth exposed to intra-oral films using the standard paralleling technique. A differentiation was made between vertical and horizontal bone loss. Clinical mobility index, pocket depth, gingival recession and papillary hemorrhagic index were also measured. There was a strong association between the Periotest value and bone loss. These results suggest that Periotest evaluation provides an objective indication of the extent of periodontal bone loss.     

High-speed filming of the Periotest measurement

Periodontal disease may be diagnosed with the Periotest technique, which involves electronically controlled and reproducible percussion of tooth. The movement on percussion was investigated with high-speed film and then compared with the return of teeth after static deflection for several seconds as has been reported previously by Lukas and Scholz. The elastic and viscous properties of the periodontium and the surrounding bony tooth socket are to a large extent non-linear. The 10-20 microns deflection of the healthy tooth represents only a fraction of static tooth mobility published by Parfitt or Schulte et al. The visco-elastic properties of a healthy tooth enabling the percussion of the Periotest tapping head to be decelerated in less than 1 ms are largely lost in periodontitis. It is this essential difference which the Periotest method utilizes.     

Duration patterns of percussion sound in healthy and periodontally affected teeth

Ten periodontally affected subjects and 10 healthy subjects were selected in order to examine the duration patterns of percussion sounds in all upper teeth, excluding the 8's. Probing depth, loss of attachment, tooth mobility by 'Periotest', bone loss and percussion sound duration via occlusal sound analyser were recorded during the pretreatment period. The following results were obtained from the study: (i) the normal duration of percussion sounds ranged from 4.40-5.33 ms; (ii) percussion sound values of periodontal patients were of longer duration than those of healthy subjects; (iii) a close correlation between duration and other individual parameters was found in all upper teeth, with the exception of molars.     

The Periotest in traumatology. Part II. The Periotest as a special test for assessing the periodontal status of teeth in children that have suffered trauma

Abstract –  The research was carried out on the upper permanent incisor teeth of 101 children aged 8–12 years attending the trauma clinic at the University Dental Hospital, Manchester, UK. The double blind, cross-over study involved Periotest readings being taken by one examiner and traditional special tests being carried out by another examiner. The traditional special tests chosen were mobility testing, percussion sounds and radiographs. The Periotest readings and special tests were then repeated at the child's recall appointment. The results revealed that there was a significant difference ( P  < 0.001) between the number of abnormalities detected by the Periotest and those detected by the traditional special tests. There was also found to be a significant difference ( P  < 0.001) in the detection of undesirable sequelae between the Periotest and the traditional special tests.     

Longitudinal measurements of tooth mobility during orthodontic treatment using a periotest

The present study was designed to investigate the alteration of tooth mobility through orthodontic treatment using a Periotest. Eighty-three crowding cases without severe skeletal discrepancies were used as subjects. For each subject, the mobility of the central and lateral incisors on both arches (U1, U2, L1, and L2) was measured immediately before and after orthodontic treatment (T1 and T2 stages) and after retention (T3 stage) by use of a Periotest. No significant differences of all the measurements were found between the left and right sides. At T1 stage, the mean values were 10.8, 10.4, 9.3, and 7.4 for U1, U2, L1, and L2, respectively. At T2 stage, the Periotest values for all the teeth increased in comparison with those at T1 stage, and significantly decreased at T3 stage compared with those at T2 stage. Negative correlations were found between the Periotest value and age, which imply that tooth mobility decreases with age. The durations of treatment and retention had low correlation with the change of tooth mobility for all the teeth. It is suggested that the tooth mobility before treatment and after retention may be one of the useful indicators for determination of the retention period.     

Splints made of wire and composite: an investigation of lateral tooth mobility in vivo

Abstract In 103 posttraumatic splints, lateral tooth mobility was measured with Periotest immediately before and after the routine splint removal. The splints were made of composite resin and an 0.017×0.025″ orthodontic steel wire. 481 teeth were measured. A statistic evaluation revealed that the immobilisation effect did not exceed normal tooth firmness. Fixation to one neighbouring tooth had less effect than fixation to two. Adjacent tooth gaps reduced the effect. Splint extensions had no influence. With the use of the Periotest device, more than 50% of all teeth with a true mobility of 20 Periotest-units or more were detectable as mobile in spite of the fixed splint.     

An evaluation of the Periotest system. Part I: Examiner reliability and repeatability of readings. Dental Implant Clinical Group (Planning Committee).

The clinical success of endosseous dental implants is related to the extent of osseointegration. Many of the presently used methods of evaluating osseointegration are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration and supporting bone stability of implants by means of microcomputer-controlled percussion. Investigators involved in a clinical study on dental implants being conducted by the Dental Implant Clinical Research Group participated in a two-part in vitro evaluation of the Periotest system. The first part, with which this article is concerned, involved each of 35 investigators taking three readings for each of 16 models designed to simulate an implant in place in the oral cavity and to cover most of the effective measuring range of the instrument. The Periotest system generally demonstrated a high degree of reliability and repeatability, with higher variability associated with specific model samples. Further evaluation of the Periotest as a research instrument will be conducted within the clinical environment of the Dental Implant Clinical Research Group study.     

In vitro splint rigidity evaluation – comparison of a dynamic and a static measuring method

Abstract – Objectives: The aim of this in vitro study was to investigate a dynamic and static tooth mobility assessment method in terms of reproducibility and correlation. Materials and Methods: A custom‐made artificial model was used. The central incisors simulated ‘injured’ teeth with increased mobility, and the lateral incisors served as ‘uninjured’ teeth with physiological mobility. To assess tooth mobility, three consecutively repeated measurements were taken, in the vertical and horizontal dimensions before and after splinting, using the Periotest method as well as the Zwick universal testing machine. Reproducibility of the measurements was tested using anova and the Bonferroni post hoc test (α = 0.05). Correlation was analysed using Spearman’s rank correlation (α = 0.05). Results: No significant differences were found when comparing the three consecutively taken Periotest values and the vertical Zwick values (P > 0.05). In the horizontal dimension, the first Zwick values differed from the second and third values (P < 0.05). Only a few random correlations (P < 0.05) were found when comparing the two assessment methods. Horizontal and vertical measurements within one method did not correlate (P > 0.05). Conclusions: The Periotest and vertical Zwick values are highly reproducible. The measurements of the two methods do not correlate; therefore, a conversion of Periotest values into metric displacement data is not feasible. The two methods provide different valuable information about tooth mobility. The Periotest method describes the damping characteristics of the periodontal ligament while the Zwick method reveals quantitative metric values.     

A multiparametric analysis of occlusal and periodontal jaw reflex characteristics in adult skeletal mandibular protrusion before and after orthognathic surgery

Periodontal jaw reflex, duration of percussion sounds, tooth mobility, and time-moment analysis of occlusal contacts by the T-scan system were recorded in seven pre-orthognathic surgery patients and six post-orthognathic surgery patients over a 2-year period. The results showed that: (i) reflex response to the pressure applied to the upper right central incisor in the lingolabial direction varied, depending on the background jaw-clenching force (BCF) of the same-sided first molar. The BCF level required to elicit excitatory reflexes was only 0 kgf, and inhibitory reflexes were clearly elicited with a BCF of 1 kgf and beyond before orthognathic surgery. After orthognathic surgery BCF levels required to elicit excitatory reflexes were 0-4 kgf, and inhibitory reflexes were elicited with a BCF of 6 kgf and above; (ii) duration of percussion sounds determined via an occlusal sound analyser decreased in both the upper right central incisor and upper right first molar while tooth mobility measured by 'Periotest(R)' increased in the upper right central incisor, but did not change in the same-sided first molar after orthognathic surgery; (iii) the time moments of occlusal contacts were symmetrical toward the midsagittal axis of the occlusal plane after orthognathic surgery. The centre of the anterioposterior occlusal contacts did not differ between pre- and post-orthognathic surgery groups.     

A prospective study to assess osseointegration of dental endosseous implants with the Periotest instrument

Long-term studies have documented the successful treatment of edentulous and partially edentulous patients with titanium implants. However, the inability to identify some non-osseointegrated implants before occlusal loading is costly to practitioners and patients. This study followed all patients (n = 40) who had implants placed over a 6-month period. The Periotest instrument was used at Stage II surgery, final impression, prosthesis placement, and 6 and 12 months after occlusal loading to quantify mobility/lack of mobility of implants with conventional 1-piece temporary healing abutments in place. The positive predictive value was 64%. The Periotest instrument was able to identify non-integrated implants only when measured at Stage II surgery and 12 months after occlusal loading, 64% of the time. However, Periotest values recorded at Stage II surgery are not valid predictors of non-osseointegrated implants 12 months post-occlusal loading.     

Tooth mobility after periodontal surgery.

Changes in tooth mobility after surgical crown lengthening procedures were examined with a modern electro-mechanical instrument (Periotest) in a total of 37 teeth in 14 patients between the ages of 18 and 55 years. Seven teeth were incisors, three canines, thirteen pre-molars and fourteen were molars. Periotest values, probing depths, bleeding indices and plaque indices were recorded after the initial preparation stage of the periodontal treatment, and further Periotest values and plaque and bleeding indices were recorded at intervals up to 3 months after surgery. In each category of teeth there was a progressive increase in tooth mobility starting immediately after surgery and peaking about the seventh day. The mobility then declined steadily to approach the base line again at about 3 months. There were statistically significant differences in mobility after surgery between tooth types (p < 0.01). Gender and age did not significantly affect the values. The pattern of post-surgical tooth mobility can be closely correlated with the known biological events of post-surgical healing.     

Influence of the implant abutment on the Periotest value: an in vivo study.

OBJECTIVE: Periotest values for dental implants depend on the type of prosthetic abutment utilized for the restoration. If Periotest value cannot be measured at the single crown, the Periotest values used for comparison must be derived from the same type of superstructure. METHOD AND MATERIALS: Fifty-nine patients were selected from a regular follow-up program. At the end of the healing period, the Periotest values of Frialit-2 implants were measured at the gingiva former and abutment. The values were then compared with the Periotest measurements obtained at the placement of the final single crown and during the first follow-up examination. RESULTS: Compared to values measured at single crowns, the Periotest value measured at gingiva formers decreased on average by 3.5. The measurement of the abutment revealed a decrease of 1.7. Until the first recall and under functional loading of implants, the Periotest value increased on average by 1.8. These differences significantly differed from 0. CONCLUSION: If measurements at different abutments such as crown abutments or single crowns are necessary, comparison of the Periotest values in accordance with the given mean values will lead to more precise results. It is recommended that Periotest measurements be performed for the first and subsequent prostheses, during all prosthetic stages, to allow comparison if some parts of the prosthetic abutment have to be replaced.     

Periotest® measurements and osseointegration of mandibular ITI implants supporting overdentures. A one‐year longitudinal study.

The Periotest values of mandibular implants, registered before and after loading by overdentures, were compared. Thirty edentulous patients with 60 Bonefit ITI implants were selected with an average age of 69 years. The Periotest values were measured 1) after a healing period of 3 months and 2) after the overdentures had been worn for a period of 12 months. Periodontal parameters were recorded at both examinations. Furthermore, 17 biopsies of mandibular bone taken from the implant sites during implant surgery were analyzed to assess the bone density. The histomorphometric evaluation was done using a point count method. At the end of the healing period. all registered Periotest values were negative, ranging from −1 to −8 with an average of 4.08. One year later, all measurements showed negative values again, ranging from −2 to −8 with an average of 4.97. The difference was statistically significant. Seventeen biopsies of mandibular bone were evaluated to determine the density. The range of bone density was from 22.4% and 90.9%. There was no correlation found between bone density and Periotest values. However, a significant correlation could be observed between mandibular atrophy and bone density.     

The Periotest method.

The Periotest is a new instrument for the diagnosis of periodontal diseases. The 'Periotest value' depends to some extent on tooth mobility, but mainly on the damping characteristics of the periodontium. The Periotest measures the reaction to a reproducible impact applied to the tooth crown. The Periotest value is a biophysical parameter.     

应用牙周动度仪研究戴用可摘局部义齿对基牙动度的影响

本研究使用Periotest牙周动度检测仪，对38名牙列缺损患者在用可摘局部义齿（RPD）修复前后分别作基牙动度的测量。结果表明，义齿修复后基牙的稳固程度有提高趋势。     

Resonance frequency analysis and damping capacity assessment. Part 2: peri-implant bone loss follow-up. An in vitro study with the Periotest and Osstell instruments

OBJECTIVE: We compared the performance of damping capacity assessment (Periotest device) to resonance frequency analysis (Osstell device) in the assessment of peri-implant bone loss in an in vitro experiment. MATERIAL AND METHODS: Screw-type oral implants were polymerized into acrylic blocks. Peri-implant bone loss was simulated by successively removing defined portions of material surrounding the implants in millimeter increments. Measurement values of both devices were compared by assessing the associated measurement errors, by calculating correlation analyses and drawing scatterplots, and by means of regression analysis referring to increasing bone loss. RESULTS: Both devices produced comparable results suggesting agreement of the measured implant stability values to the actual loss of peri-implant resin. There was a noticeable correlation of the Periotest and Osstell implant stability values. CONCLUSION: The results of this experiment suggest agreement in predicting the actual implant stability with both the instruments with the Osstell instrument being the more precise device.     

A multiparametric analysis of occlusal and periodontal jaw reflex characteristics in young adults with normal occlusion

summary Periodontal jaw reflex, duration of percussion sounds, tooth mobility, and time-moment analysis of occlusal contacts by the T-scan system was recorded in nine periodontally healthy volunteers. The results showed that (i) reflex responses to the pressure applied to the uppercentageral incisors in the lingolabial direction varied, depending on the background jaw-clenching force (BCF) of the same-sided first molars. The BCF levels to elicit excitatory reflexes were 6–8Kgf, and inhibitory reflexes were clearly elicited with a BCF of l0Kgf and beyond. (ii) Duration of percussion sounds via an occlusal sound analyser (4.73–4.84mS: upper first molars. 4.89–5.00mS: uppercentageral incisors) and tooth mobility using a 'Periotest' (3.3–3.5: upper first molars, 5.5–5.6: uppercentageral incisors) showed a normal value. (iii) The time moments of occlusal contacts were symmetrical toward the midsagittal axis of the occlusal plane. The centre of the anterioposteriol occlusal contacts was located in the first molar regions.     

Periotest method: Implant-supported framework fit evaluation in vivo

Statement of problem. In implant prosthodontics an accurate fit of the framework to the supporting implants is paramount. However, microgaps occur, unknown to the clinician until complications arise that implicate errors in fit. Therefore prosthodontics would welcome a tool or instrument that provides an objective evaluation of the fit at the implant prosthodontic interface.Purpose. This clinical investigation determined whether a correlation existed between the laboratory laser measurement of the abutment analog-framework fit and the intraoral abutment-framework fit as measured by the Periotest method.Material and methods. Fifteen subjects received implant-supported remote fixed partial denture supported by five (11 subjects) or six (4 subjects) implants in the mandibular jaw opposed by a complete maxillary denture. Laser videography was used to quantify the fit of the framework to its respective master cast with six measurements, while the fit of the framework in the mouth was quantified with the Periotest method. Data were statistically analyzed with correlation analyses and multiple regression.Results. The overall correlation coefficient between the two methods was r = 0.51. Regression analysis of variance revealed that the intercept of the laser videography measurement was significant (p ≤ 0.05). The mean Periotest values and standard deviation for the abutment-framework interface were negative (-7.3 ± 1.2). The variance in part for the Periotest values was explained by the misfits in the vertical axis (ΔZ, + 0.471) and in the misfit direction of the centroids in the x-y plane (X-YVD, -0.244).Conclusion. There was no single variable among the six measurement variables that strongly correlated with the Periotest method in the identification of misfit at the bearing surface as indicated by the Periotest value measurements. The misfit laser variables that were weakly correlated to the Periotest values should be observable clinically with greater scrutiny. (J Prosthet Dent 1998;79:648-57.)