Clinical diagnosis advancements in periodontics

Clinical diagnosis advancements in periodontics

1. ADVANCES IN CLINICAL DIAGNOSIS PRESENTER- DR.TANYA ATTRE DEPARTMENT OF PERIODONTOLOGY & ORAL IMPLANTOLOGY

2. Contents INTRODUCTION DIAGNOSIS, NEED OF DIAGNOSIS, CONVENTIONAL CLASSIFICATION, LIMITATIONS, ADVANCE DIAGNOSTIC AIDS PERIODONTAL PROBES GENERATIONS OF PERIODONTAL PROBES ADVANCES IN OCLUSAL ANALYSIS T-SCAN ORAL MALODOUR GAS CHROMATOGRAPHY, PORTABLE VOLATILE SULPHUR COMPOUND, ELECTRONIC NOSE, TONGUE SULFIDE PROBE, DIAMOND PROBE CALCULUS DETECTOR FIBEROPTIC ENDOSCOPY, FLUORESENCE, SPECTRO-OPTICAL TECHNOLOGY GINGIVAL TEMP TOOTH MOBILITY & AI IN PERIODONTOLOGY

3. INTRODUCTION “Diagnosis is not the end, but the beginning of practice ”- Martin H Fischer Periodontal diseases are prevalent human diseases defined by the signs and symptoms of gingival inflammation and periodontal tissue destruction. These diseases are conventionally diagnosed by clinical evaluation of the signs of inflammation in the gingiva without periodontal tissue destruction (gingivitis) or by the presence of both inflammation and tissue destruction (periodontitis ) The traditional clinical diagnosis is made by measuring either the loss of connective tissue attachment to the root surface (clinical attachment loss) or the loss of alveolar bone (radiographic hone loss) Ko TJ, Byrd KM, Kim SA. The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future. Diagnostics (Basel). 2021 May 22;11(6):932 .

4. CARRANZA 10 TH EDITION

5. DIAGNOSIS Art of distinguishing one disease from another and determination of nature, location and causes of a disease. Periodontal diagnosis “ Recognizing a departure from normal in the periodontium and distinguishing one disease from another. It must be based on compilation of information from the medical and dental history, from signs and symptoms of disease and from clinical and radiographic examination of the patient.” Ko TJ, Byrd KM, Kim SA. The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future. Diagnostics (Basel). 2021 May 22;11(6): 932

6. Need of periodontal diagnosis Diagnosis of specific periodontal diseases. Identification of sites or subjects at an increased risk of experiencing the progression of periodontal destruction. Treatment planning Monitoring of therapy. Ko TJ, Byrd KM, Kim SA. The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future. Diagnostics (Basel). 2021 May 22;11(6):932.

7. Clinical diagnosis- Bleeding on probing Pocket depth Attachment level measurements Radiographic diagnosis - IOPA Bitewing Panoramic radiography Microbiological diagnosis – Culturing CONVENTIONAL DIAGNOSIS METHOD Ko TJ, Byrd KM, Kim SA. The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future. Diagnostics (Basel). 2021 May 22;11(6): 932

8. Advancement in Clinical Diagnosis Periodontal Probing Occlusal analysis Tooth mobiIity Oral malodor Calculus Detection Gingival Temperature Ko TJ, Byrd KM, Kim SA. The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future. Diagnostics (Basel). 2021 May 22;11(6):932.

9. PERIODONTAL PROBES The word probe is derived from the Latin word probo , which means “to test.” Periodontal probes are used primarily to detect and measure periodontal pockets and clinical attachment loss . In addition, they are used to locate calculus; measure gingival recession, width of attached gingiva, and size of intraoral lesions; identify tooth and soft-tissue anomalies; locate and measure furcation involvements; and determine mucogingival relationships and bleeding tendencies . However, periodontal probing has its limitations Ramachandra SS, Mehta DS, Sandesh N, Baliga V, Amarnath J. Periodontal probing systems: a review of available equipment. Compend Contin Educ Dent. 2011 Mar;32(2):71-7.

10. 1882 -John W Riggs first described the periodontal probe as a tool in the diagnosis of periodontal disease . In 1925- F.V. Simmonton stated that “the only way to determine the existence and extent of pyorrhea was by the measurement of pockets”. He described the periodontal probe and its uses In 1958- Orban described the periodontal probe as the ”eye of the operator beneath the gingival margin. HISTORY OF PERIODONTAL PROBES Ramachandra SS, Mehta DS, Sandesh N, Baliga V, Amarnath J. Periodontal probing systems : a review of available equipment. Compend Contin Educ Dent. 2011 Mar;32(2):71-7 .

11. Hanford and Patten’s design of a periodontal probe then called a periodontometer and made of silver is nearly same in appearance as the probes that are routinely used in clinical practice today . In1992, B.L.Philstrom created a classification of periodontal probes which included 3 generations and I n 2000, Watts included fourth and fifth generations. Ramachandra SS, Mehta DS, Sandesh N, Baliga V, Amarnath J. Periodontal probing systems: a review of available equipment. Compend Contin Educ Dent. 2011 Mar;32(2):71-7.

12. 1. Periodontal probes suitable for a general dental practice: a . First generation b . Second generation 2 . Periodontal probes suitable for a dental practice with an interest in periodontics: a . First generation b . Second generation c . Third generation (if computerization is adequate) 3 . Periodontal probes suitable for a specialty periodontal practice and university and research institutions: a . First generation b . Second generation c . Third generation d . Fifth generation RECENT CLASSIFICATION BASED ON PERIODONTAL PROBE SELECTION Ramachandra SS, Mehta DS, Sandesh N, Baliga V, Amarnath J. Periodontal probing systems: a review of available equipment. Compend Contin Educ Dent. 2011 Mar;32(2):71-7.

13. These are conventional and manual/hand-held probes made up of stainless steel or plastic. They are not attached with any pressure or force measuring device. The working ends are round, tapered, flat or rectangular with smooth rounded end. 1 ST GENERATION PROBE Periodontal Probe: A review; Dr. Sohini Banarjee , Prof. Dr. Abhijit Chakroborty , Prof. Dr. T. K. Paul. (JIDA, WB Vol 29 , No 2 , July 2013

14. UNC-15 PROBE GOLDMAN FOX PROBE WHO PROBE WILLIAM PROBE

15. MICHIGAN “O” PROBE

16. FIRST GENERATION PROBE Williams probe has markings at 1, 2, 3, 5, 7, 8, 9, and 10 mm. Marquis probe or Hu- friedy color coded probe is color coded by alternately colored or black and silver bands that mark 3, 6, 9, and 12 mm. Michigan O probe with Williams markings has circumferential lines at 1 mm, 2 mm, 3 mm, 5 mm, 7 mm, 8 mm, 9 mm, and 10 mm. PCP12 probe with Marquis markings has alternating shades every 3 mm. CPITN probe has markings at 3.5, 5.5, 8.5, and 11.5mm.

17. PERIODONTAL PROBE GENERATIONS First Generation (Conventional)

18. Metal probes, which are standard in traditional periodontal probing, pose a risk of microabrasion to the titanium surface of implants. Such abrasions can increase surface roughness, creating niches for bacterial colonization and potentially leading to peri -implant diseases. In contrast, non-metallic probes, particularly those made of carbon or plastic, are less likely to cause such damage due to their softer and less abrasive nature. These probes are recommended to reduce the risk of implant surface modification. PLASTIC COLORVUE PROBE Ramachandra SS, Mehta DS, Sandesh N, Baliga V, Amarnath J. Periodontal probing systems: a review of available equipment. Compend Contin Educ Dent. 2011 Mar;32(2):71-7.

19. SECOND GENERATION Second generation probe are pressure sensitive To improve standardization of controlled probing pressure. Weinberg et. al. Stated that, Controlled force of 20-25 gms during probing, reduce examiner error & made depth changes of less than 2 mm which was clinically meaningful Pressure should not exceed 0.2 N/mm2 SS, Ramachandra & Mehta, Dhoom & Sandesh , Nagarajappa & Baliga , Vidya & Amarnath , Janardhan . (2011). Periodontal probing systems: A review of available equipment. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995). 32. 71-7.

20. True Pressure Sensitive (TPS) probe Vine valley Probe YEAPLE PROBE

21. MATERIAL & METHOD The investigation was performed on 57 patients, each of them subjected to both conventional and electronic probing. The tolerance degree for each probing type and also the time consumed with probing and periodontal charting were recorded . RESULT- Periodontal probing with an electronic probe gave better results as to the accuracy of measurements, tolerance level and time consumed , appearing as an exceptionally precise method in establishing the diagnosis, as well as in assessing the treatment results.

22. THIRD GENERATION Probes with controlled probing force that are capable of automated computerized data recording Probes available: Florida probe Toronto probe Foster-miller probe Interprobe

23. Foster Miller probe Florida probe SS, Ramachandra & Mehta, Dhoom & Sandesh , Nagarajappa & Baliga , Vidya & Amarnath , Janardhan . (2011). Periodontal probing systems: A review of available equipment. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995). 32. 71-7.

24. Ultrasonographic probe (4 th generation) Described by Orban as the ‘the eyes of the operator beneath the gingival margin’, periodont ,   8. . Simonton (1925) 9  and Box (1928) 10  were among the first to advocate the routine use of calibrated probes to measure and document the extent of detachment of periodontal tissues from root surfaces 11 . Pihlstrom (1992) classified probes into three generations 12 . In 2000, Watts extended this classification by adding fourth- and fifth-generation probes 13 . These are three dimensional probes. These probes help in measuring the sequential probe positions along gingival sulcus. Its goal is to obtain a precise and continuous reading of the base of the sulcus or pocket. The 3d visualization provides quite accurate information about the periodontal pocket. These probes are currently under development . 4 TH GENERATION PROBE

25. Probes are being designed to be 3D and noninvasive: an ultrasound or other device is added to a fourth-generation probe Fifth-generation probes aim to identify the attachment level without penetrating it. FIFTH GENERATION PROBE

26. ULTRASONOGRAPHIC PROBE The probe is designed to have a removable tip, space for a 2-mm active area transducer housed at the base of this tip, a water line input that runs through the probe handle and empties into a small open area around the transducer, and an electronics input–output cable that also runs through the base and is connected to the transducer . SS, Ramachandra & Mehta, Dhoom & Sandesh , Nagarajappa & Baliga , Vidya & Amarnath , Janardhan . (2011). Periodontal probing systems: A review of available equipment. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995). 32. 71-7.

27. OCCLUSAL ANALYSIS

28. Articulating paper foils and ribbons have been used extensively in clinical practice as occlusal indicators. Research on articulating paper mark size has revealed that the size of an articulating paper mark does not describe occlusal forces- Carey et al (2007) As an alternative method to the operator’s subjective interpretation of articulating mark appearance, computerized occlusal analysis is available to the practitioner ADVANCES IN OCCLUSAL ANALYSIS Arihant Bathiya , Sweta Kale Pisulkar . Digital occlusal analysis using T scan: Its role, mechanism, accuracy and application. Medical Science, 2020, 24(105), 2826-2834

29. PARTS OF T-SCAN Arihant Bathiya , Sweta Kale Pisulkar . Digital occlusal analysis using T scan: Its role, mechanism, accuracy and application. Medical Science, 2020, 24(105), 2826-2834

30. APPLICATION Occlusal Corrections after definitive rehabilitation Implant dentistry: Occlusal overloading being the proven factor for implants complications. It is very cumbersome task to identify overloading contact by articulating paper, sometime it not achieved with accuracy. Occlusal overloading can be identified by T scan ( Pyakurel et al., 2013), ( Sidana et al., 2013) and ( Garg , 2007) . Implant occlusion can be successfully managed using T scan (Dario, 1995) and ( Luo et al., 2019 ). Diagnostic screening Orthodontic treatment Temporomandibular joint Arihant Bathiya , Sweta Kale Pisulkar . Digital occlusal analysis using T scan: Its role, mechanism, accuracy and application. Medical Science, 2020, 24(105), 2826-2834

31. In 2006, a USB plug-in recording handle and new generation of software were released as the t-scan occlusal analysis system. The system displays a recorded occlusal “force movie,” which illustrates the various occlusal pressures with colors during playback. The darker colors represent low occlusal pressures and the brighter colors indicate higher occlusal pressures. The t-scan system is a valuable tool that aids in the diagnostic process of analyzing a patient’s bite to show what is and what is not functioning properly. T-SCAN Arihant Bathiya , Sweta Kale Pisulkar . Digital occlusal analysis using T scan: Its role, mechanism, accuracy and application. Medical Science, 2020, 24(105), 2826-2834

32. 3-dimensional dental patient is assembled from the data scanned from the casts of a patient’s dentition. This provides quantitative information that would aid in the assessment of his chewing function and in identifying the occlusal interferences. Further, the sequential comparison of these occlusal contacts enables the dentist to identify the changes in the patient’s occlusion as time elapses. Arihant Bathiya , Sweta Kale Pisulkar . Digital occlusal analysis using T scan: Its role, mechanism, accuracy and application. Medical Science, 2020, 24(105), 2826-2834

33. Arihant Bathiya , Sweta Kale Pisulkar . Digital occlusal analysis using T scan: Its role, mechanism, accuracy and application. Medical Science, 2020, 24(105), 2826-2834

34. ORAL MALODOUR

35. Major compounds that contribute to oral malodor are volatile sulfur compounds such as hydrogen sulfide , methyl mercaptan and dimethyl sulfide . Additionally, propionic acid and butyric acid, cadaverine , indole , and scatole , have been reported to cause oral malodor which results from the proteolytic degradation by predominantly anaerobic Gram negative microorganisms associated with gingivitis and/or periodontitis HALITOSIS

36. GAS CHROMATOGRAPHY Gas chromatography (GC) with flame ionization detection has been applied to measure oral malodor . A number of volatile components have been identified by GC . Gas Chromatography equipped with a indium oxide semiconductor gas sensor (SCS), which is highly sensitive to all kinds of VSC's has been developed recently. It measures each VSC's separately, whereas other devices cannot detect each separately.

37. PORTABLE VOLATILE SULFUR MONITOR

38. PORTABLE VOLATILE SULFUR MONITOR

39. FITSCAN® Breath Checker which is an innovative palmsize monitor that detects and measures the presence of breath odors (VSCs ). It measures odor in seconds and results are displayed similar to organoleptic method.

40. An artificial nose that has the same capacities as the human nose would be ideal. Originally these devices have been developed for quantitative assessments of smells in food or beverages. However, an application to diagnosis of halitosis appears reasonable. Preliminary data indicates that this device has a potential to be used as a diagnostic tool to detect odors. ELECTRONIC NOSE

41. CALCULUS DETECTION Meissner G, Kocher T. Calculus-detection technologies and their clinical application. Periodontol 2000. 2011 Feb;55(1):189-204 .

42. Current technologies for calculus identification include; 1. detection-only systems (a miniaturized endoscope) 2. device based on light reflection 3. laser that activates the tooth surface to fluoresce) as well as combined calculus-detection and calculus-removal systems [an ultrasonic oscillation based system that analyzes impulses reflected from the tooth surface, and a system combining erbiumdoped yttrium aluminium garnet ( Er:YAG ) and diode lasers] Meissner G, Kocher T. Calculus-detection technologies and their clinical application. Periodontol 2000. 2011 Feb;55(1):189-204 .

43. Meissner G, Kocher T. Calculus-detection technologies and their clinical application. Periodontol 2000. 2011 Feb;55(1):189-204 .

44. Meissner G, Kocher T. Calculus-detection technologies and their clinical application. Periodontol 2000. 2011 Feb;55(1):189-204 .

45. Geisinger ML, Mealey BL, Schoolfield J, Mellonig JT. The effectiveness of subgingival scaling and root planing : an evaluation of therapy with and without the use of the periodontal endoscope. J Periodontol 2007: 78: 22–28

46. Meissner G, Kocher T. Calculus-detection technologies and their clinical application. Periodontol 2000. 2011 Feb;55(1):189-204 .

47. Meissner G, Kocher T. Calculus-detection technologies and their clinical application. Periodontol 2000. 2011 Feb;55(1):189-204 .

48. GINGIVAL TEMPERATURE Rams, T. E., Slots, J. (2024). Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis. Clinical and Experimental Dental Research, 10, e891

49. An electronic temperature probe ( PerioTemp Probe System, ABIODENT Inc.) measured absolute subgingival and sublingual site temperatures and determined normalized differential values of subgingival temperature relative to sublingual temperature . TEMPERATURE SENSITIVE PROBE Rams, T. E., Slots, J. (2024). Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis. Clinical and Experimental Dental Research, 10, e891

50. PERIO-TEMP PROBE The temperature probe designated the subgingival temperature as either “hot” (red light) or “cool” (green light) Rams, T. E., Slots, J. (2024). Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis. Clinical and Experimental Dental Research, 10, e891

51. STUDY BY RAM & SLOT - Hot periodontal pockets had an average depth of 7.9 ± 1.3 (SD) mm (range 6‒10 mm) per patient, and cool periodontal pockets an average depth of 7.5 mm ± 1.3 (SD) (range 6‒10 mm) Hot periodontal pockets per patient showed significantly higher temperatures (averaging 37.03°C, range 36.38– 38.31°C) than cool periodontal pockets (averaging 36.58°C, range 34.34–38.0°C) (p = 0.031). Rams, T. E., Slots, J. (2024). Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis. Clinical and Experimental Dental Research, 10, e891

52. Hot periodontal sites with elevated levels of P. gingivalis , P. intermedia / nigrescens , P. micra , and A.actinomycetemcomitans and cool periodontal sites with health‐related Capnocytophaga species and viridans streptococci ( Haffajee et al., 1992c; Rams & Slots, 2023 ). High subgingival temperatures may indicate an increased risk for periodontal breakdown ( Haffajee et al., & Lindskog et al .). Hot periodontal sites were more than twice as likely as cool periodontal sites to experience progressive periodontitis ( Haffajee et al .,). whereas shallow pockets with cool temperature and bleeding on probing demonstrated progressive attachment loss in only 1.4% of sites ( Haffajee et al .,)

53. Socransky and Haffajee 1994 Suggested that Endotoxins of infecting bacteria, especially lipopolysaccharides (IPS) from Gram-negative organisms are exogenous pyrogens that stimulate macrophages to release endogenous pyrogens , producing fever Bacteria respond to changes in environmental temperature. STUDIES Rams, T. E., Slots, J. (2024). Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis. Clinical and Experimental Dental Research, 10, e891

54. TOOTH MOBILITY Kim GY, Kim S, Chang JS, Pyo SW. Advancements in Methods of Classification and Measurement Used to Assess Tooth Mobility: A Narrative Review. J Clin Med. 2023 Dec 27;13(1):142.

55. Tooth mobility refers to how loose a tooth is from the alveolar socket. The factors that influence tooth mobility include the height of the supporting alveolar bone, the width of the periodontal ligament, the presence of inflammation, the shape of the root(s), and the number of roots The evaluation is performed by placing the handles of the dental instruments on either side of the tooth’s mesiodistal axis and applying moderate pressure alternately, assessing the handle of the other instrument . Vertical tooth mobility refers to the degree to which the tooth can move downward within the alveolar socket. TOOTH MOBILITY Kim GY, Kim S, Chang JS, Pyo SW. Advancements in Methods of Classification and Measurement Used to Assess Tooth Mobility: A Narrative Review. J Clin Med. 2023 Dec 27;13(1):142.

56. In the early stages of device development, a static loading method was utilized to measure tooth mobility. However , this method is subjective, has low reproducibility, and presents challenges in achieving precise numerical measurements Subsequently , a dynamic loading method was developed to measure tooth mobility. This method enabled the accurate measurement and quantification of tooth mobility TOOTH MOBILITY Kim GY, Kim S, Chang JS, Pyo SW. Advancements in Methods of Classification and Measurement Used to Assess Tooth Mobility: A Narrative Review. J Clin Med. 2023 Dec 27;13(1):142.

57. DEVICES DISPLACEMENT MEASURING DEVICE STRAIN MEASURING DEVICES MODEL MEASURING DEVICES 1. 3. 2. Kim GY, Kim S, Chang JS, Pyo SW. Advancements in Methods of Classification and Measurement Used to Assess Tooth Mobility: A Narrative Review. J Clin Med. 2023 Dec 27;13(1):142.

58. Displacement Measuring Devices Konermann , A.; Al- Malat , R.; Skupin , J.; Keilig , L.; Dirk, C.; Karanis , R.; Bourauel , C.; Jäger , A. In vivo determination of tooth mobility after fixed orthodontic appliance therapy with a novel intraoral measurement device. Clin . Oral Investig . 2017, 21, 1283–1289

59. Methods Three experienced periodontists were asked to push tooth #16 into a buccal position to in a typodont model with different mobility (M1−M2). Tooth position was obtained using an intraoral scanner and files were compared in metrology software. Mobility was calculated at three reference points at the cervical (C), middle (M), and occlusal (O) regions of the buccal surface of the tooth to determine the linear deviation in the three axes (x, y, and z). Reliability was determined by intraclass -correlation coefficient, differences between M1 and M2 determined by  t  test, and the analysis of variance (ANOVA) was used to compare the data at the C-M-O regions. Conclusion A novel technique to assess tooth mobility based on intraoral scanner measurements provided reliable data in an in vitro experiment. Meirelles , L.; Siqueira , R.; Garaicoa-Pazmino , C.; Yu, S.H.; Chan, H.L.; Wang, H.L. Quantitative tooth mobility evaluation based on intraoral scanner measurements. J. Periodontol . 2020, 91, 202–208

60. Strain-Measuring Devices Picton’s Gauge Strain-Measuring Devices uses resistance wire strain gauges to measure tooth mobility . Strain gauges detect the vertical movement of teeth, measuring displacement or mobility . One end of the gauge is attached to a single tooth, while the other end is connected to adjacent teeth through a spring. The displacement of the test tooth relative to adjacent teeth is detected by two strain gauges . The measurement of each tooth requires the insertion of a custom assembly. Using these custom assemblies, tooth stress and displacement are measured, and this information is recorded through a Wheatstone bridge circuit. Kim GY, Kim S, Chang JS, Pyo SW. Advancements in Methods of Classification and Measurement Used to Assess Tooth Mobility: A Narrative Review. J Clin Med. 2023 Dec 27;13(1):142.

61. Modal Measuring Devices Modal analysis has emerged as the predominant approach within electronic devices employed for assessing tooth mobility. Modal Measuring Devices Kim GY, Kim S, Chang JS, Pyo SW. Advancements in Methods of Classification and Measurement Used to Assess Tooth Mobility: A Narrative Review. J Clin Med. 2023 Dec 27;13(1):142.

62. Developed by Meredith and his co workers 20 years back. This method evaluates the stiffness of the bone-implant interface by means of a signal transducer connected to a frequency response analyzer ( Osstell ; integration diagnostics, göteborg , sweden ). Osstell displays the peak of a frequency-amplitude plot. Resonance frequency of the transducer-implant unit is calculated. Implant stability quotient (ISQ) is displayed as a number between 1 and 100 RESONANCE FREQUENCY ANALYSIS

63. AI (Artificial Intelligence) and ML (Machine Learning) can significantly contribute to the field of periodontics by enhancing diagnosis, treatment planning, and patient outcomes. Here's how AI/ML can help in periodontics : Early Detection and Diagnosis Personalized Treatment Planning Enhanced Decision Support Monitoring and Follow-Up Educational Tools for Patients and Dentists AI IN PERIODONTAL DIAGNOSIS Pitchika V, Büttner M, Schwendicke F. Artificial intelligence and personalized diagnostics in periodontology: A narrative review. Periodontology 2000. 2024;95:220-231

64. These advances are reshaping the landscape of periodontal diagnosis, offering more accurate, efficient, and patient- centered care, which ultimately improves outcomes and enhances overall oral health. CONCLUSION

65. Ko TJ, Byrd KM, Kim SA. The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future. Diagnostics (Basel). 2021 May 22;11(6): 932 Ramachandra SS, Mehta DS, Sandesh N, Baliga V, Amarnath J. Periodontal probing systems: a review of available equipment. Compend Contin Educ Dent. 2011 Mar;32(2): 71-7 Periodontal Probe: A review; Dr. Sohini Banarjee , Prof. Dr. Abhijit Chakroborty , Prof. Dr. T.K . Paul. (JIDA, WB Vol 29 , No 2 , July 2013 Meissner G, Kocher T. Calculus-detection technologies and their clinical application. Periodontol 2000. 2011 Feb;55(1):189-204. Rams, T. E., Slots, J. (2024). Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis. Clinical and Experimental Dental Research, 10, e891 REFERENCES

66. Konermann , A.; Al- Malat , R.; Skupin , J.; Keilig , L.; Dirk, C.; Karanis , R.; Bourauel , C.; Jäger , A. In vivo determination of tooth mobility after fixed orthodontic appliance therapy with a novel intraoral measurement device. Clin . Oral Investig . 2017, 21, 1283–1289 Geisinger ML, Mealey BL, Schoolfield J, Mellonig JT. The effectiveness of subgingival scaling and root planing : an evaluation of therapy with and without the use of the periodontal endoscope. J Periodontol 2007: 78: 22–28 kasaj A, Moschos I, Rohrig B, Willershausen B. The effectiveness of a novel optical probe in subgingival calculus detection. Int J Dent Hyg 2008: 6: 143–147 . Arihant Bathiya , Sweta Kale Pisulkar . Digital occlusal analysis using T scan: Its role, mechanism, accuracy and application. Medical Science, 2020, 24(105), 2826-2834

67. Meirelles , L.; Siqueira , R.; Garaicoa-Pazmino , C.; Yu, S.H.; Chan, H.L.; Wang, H.L. Quantitative tooth mobility evaluation based on intraoral scanner measurements. J. Periodontol . 2020, 91, 202–208 Kim GY, Kim S, Chang JS, Pyo SW. Advancements in Methods of Classification and Measurement Used to Assess Tooth Mobility: A Narrative Review. J Clin Med. 2023 Dec 27;13(1):142.

68. THANKYOU