chairside diagnostic aid for diagnosing periodontitis

chairside diagnostic aid for diagnosing periodontitis

1. CHAIRSIDE DIAGNOSTIC TOOLS- PAST, PRESENT AND FUTURE BY –SRISHTY SHARMA FIRST YEAR MDS DEPT OF PERIODONTICS

2. CONTENTS:- INTRODUCTION CHAIRSIDE KIT TYPES OF DIAGNOSIS CLINICAL DIAGNOSIS RADIOGRAPHIC DIAGNOSIS BIOMARKERS DIAGNOSIS REFRENCES

3. INTRODUCTION DIAGNOSIS - art of identifying a disease using scientific knowledge and differentiating it from other entities. Involves DETERMINES

4. DIAGNOSTIC TOOLS method or test used to help diagnose a disease or condition

5. CHAIRSIDE KIT

6. VARIOUS TYPES OF DIAGNOSIS CLINICAL DIAGNOSIS RADIOGRAPHIC DIAGNOSIS BIOMARKER DETECTION

7. CLINICAL DIAGNOSIS

8. CHAIRSIDE DIAGNOSIS OF CLINICAL ATTACHMENT AND POCKET DEPTH CONVENTIONAL

9. Drawback of conventional probing

10. FIRST GENERATIONS OF PROBE

11. 2 ND GENERATION – PRESSURE SENSITIVE PROBES - EXAM PLE TPS probe comes with visual guidance apply force controlled force of .20N 3 RD GENERATION PROBES- computerized probes detect CEJ FLORIDA PROBE- .computerized probing system apply constant probing force of .15N NEW GENERATIONS OF PROBE

12. 5 TH GENERATION PROBES- ULTRASONOGRAPHIC PROBES EXAMPLE-I NTERPROBE - designed to be easier to use with graphical and acoustic feedback and an ergonomic wireless design. 4 TH GENERATION PROBE- 3D PROBES WITH SEQUENTIAL PROBING

13. Drawbacks of present probing system

14. multifunctional probes using nanotechnology and microfabrication in probe design using titanium and platinum sensors with silver particles FUTURE OF PROBING

15. CHAIRSIDE DIAGNOSIS OF GINGIVAL INFLAMMATION 1> bleeding on probing 2> clinical evaluation of inflammation like- colour change,edema,pain,surface texture CONVENTIONAL

16. Drawbacks of bleeding on probing

17. GINGIVAL TEMPERATURE -Thermal probes are sensitive devices for measuring early inflammation in gingival tissues (kung et al) Subgingival temperature > normal gingiva Example- perio temp probe New methods

18. MEASUREMENT OF GINGIVAL CREVICULAR FLOW Increased gcf flow+ bleeding = early sign of inflammation ( Ciancio 1986, Greenstein1984 and Muhlemann 1971 PERIOTRON -

19. Chairside diagnosis of tooth mobility CONVENTIONAL MILLER’S INDEX

20. PERIOTEST- electronic wireless device for assessing periodontal disease parameters (including mobility) of teeth and osseointegration of dental implant it measures duration per impact. OSTELL IDX- non contact device using resonance frequency and increases reproducibility

21. Chairside diagnosis of plaque and calculus CONVENTIONAL Using explorers, probes and tactile sensations

22. PERIOSCOPY- miniature periodontal endoscope - subgingival visualisation under magnification of 48X New methods

23. PERIOSCAN- diagnosis mode to detect calculus deposits and a treatment mode for the conventional ultrasonic debridement with different power levels. DIAGNODENT- pen-like probe that sends a safe, painless laser beam into the tooth to detect the auto fluorescent signal from calculus lesions. The Diagnodent can measure a wide range of fluorescence intensities that are displayed on a digital display as a series of relative calculus detection values.

24. RADIOGRAPHIC DIAGNOSIS Conventional two-dimensional oral radiography is the most widely used imaging method for diagnosing periodontal disease. a reliable tool in observation of alveolar bone loss caused by periodontal disease 2D SYSTEM but detect bone level, bone destruction pattern, marginal contour, and extent of bone loss. CONVENTIONAL

25. computer-assisted densitometric image analysis (CADIA )- computerized video camera and an image analyzing processor to measure the light that is transmitted through the radiographs . CADIA system also evaluates bone regeneration in the extraction socket or the bone density changes in a furcation

26. COMPUTERIZED TOMOGRAPHY- Used oral health assessment as an extraoral radiography method. CT can build 3D image models without superimposition of structures. CONE BEAM TOMOGRAPHY- Reconstruct 3D images of the patient’s dental and maxillofacial areas (transverse section, sagittal section, and buccal section) using software. 3D dental CBCT technology is more advantageous in bone and periodontal pocket assessment than the conventional 2D radiography 3 dimensional imaging

27. CONE BEAM VOLUMETRIC TOMOGRAPHY- CT based technique offers high resolution for assessment after regenerative therapy. TUNED APERTURE COMPUTER TOMOGRAPHY- Series of axial cross-sectional images QUANTITATIVE COMPUTED TOMOGRAPHY- detailed bone mineral density information with 3d anatomic localization

28. ENDOSCOPIC CAPILLAROSCOPY- record the microvasculature of the periodontal pocket and gingival crevice in vivo. - sub-millimeter-sized optical fiber into the periodontal pocket -green light with a wavelength of 520 nm for illumination absorbed by both oxygenated and deoxygenated blood -cells appear dark on a green background, allowing the high-resolution imaging of the periodontal pocket microcirculation.

29. Chairside diagnosis by biomarkers

30. BIOMARKERS B iological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease

31. Microbiological biomarkers Subgingival microbiome consists of 700+ species Main bacteria associated with periodontal diseases Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia ( Tf ), Actinobacillus actinomycetemcomitans (Aa), Prevotella intermedia (Pi), Fusobacterium nucleatum ( Fn )

32. Sample collection for Microbiological kit

33. BANA TEST(PERIOSCAN) Bacteroides forsythus , Pg, Treponema denticola as well as certain Capnocytophaga species that produce trypsin‑like enzyme. The presence of this enzyme in a plaque sample can be elicited by the hydrolysis of a synthetic trypsin substrate, N‑benzoyl‑DL‑arginine‑2‑naphthylamide Perioscan had a sensitivity of 99% and a specificity of 55% EVALUSITE- rapid microbiological assay kit pathogens: Aa, Pg, and Pi. PRINCIPLE- antibody-bounded sandwich-type enzyme-linked immunosorbent RESULT- 10 min

34. OMNIGENE- nucleic acid technology genomic probe - Pi, Pg can be detected with the aid of purified DNA fragments. - possess 96% sensitivity and 86% specificity DNA PROBES- specific and determine phenotypic markers • Has great specificity and sensitivity Very expensive • The minimal detection limits for particular species are 103–105 cells

35. GENETIC ASSAY KIT 1. PERIODONTITIS SUSCEPTIBILITY TEST- It evaluates occurrence of IL-1ALPHA and IL-1BETA

36. 2. MY PERIO ID – detect patient genetic susceptibility to pdl diseases. detect DNA polymorphism within IL-1 GENE

37. BIOCHEMICAL BIOMARKERS

38. PERIOCHECK- - colorimetric test -c heck neutral proteases such as collagenases, elastases, and proteinases in GCF - gel containing insoluble dye‑labelled collagen fibrils (remazobrilliant blue‑collagen substrate powder) and incubated - In presence of protease – strip turns ---- blue -Interproximal sites cannot be sampled PERIOSAFE- measure MMP-8 - useful for distinguishing between active and inactive sites with fast and easy analysis and detecting asymptomatic, ongoing periodontitis before clinical and radiographic signs appear

39. POCKETWATCH AND PERIOGARD- measures AST - abundant gingival epithelial cells level of AST in GCF can be used as a strong indicator of gingiva tissue destruction

40. ORAL FLUID NANOSENSOR TEST-OFNATEST- rapid detection of multiple salivary proteins and nucleic acid targets. It analyzes saliva for the presence of four salivary mRNA biomarkers (SAT, ODZ, interleukin [IL]‑8, and IL‑1β) and two salivary proteomic biomarkers (thioredoxin and IL‑8) with high specificity and sensitivity

41. FUTURE OF BIOMARKER diagnosis Artificial intelligence technology, higher accuracy in diagnosis and better prediction in prognosis are expected Early stage detection and rapid diagnosis

42. references Ko TJ, Byrd KM, Kim SA. The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future. Diagnostics. 2021 May 22;11(6):932. Singh G, Gupta G. Chairside Diagnostic Kits in Periodontal Practice: an Overview. International Journal of Health Sciences.:96-9. Malagi S. Chairside diagnostic test kits in periodontics–a review. International Arab Journal of Dentistry. 2012;3(3):4. Mani A, Anarthe R, Marawar PP, Mustilwar RG, Bhosale A. Diagnostic kits: An aid to periodontal diagnosis. Journal of Dental Research and Review. 2016 Jul 1;3(3):107.

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