Art Sondas y Radiografias

The Use of Periodontal Probes and Radiographs in Clinical Trials of Diagnostic Tests
Michael S.

Reddy*
Alabama

*Department of Periodontics, University of Alabama School of Dentistry, Birmingham,

Abstract Periodontal probing attachment level measurements and intraoral radiographs are used to assess the level of the clinical attachment and bone support in the diagnosis of Periodontitis.Together these physical measurements of tooth support comprise the standard against which new diagnostic tests are compared. Since probing and radiographs provide a measure of the severity of attachment or bone loss at one point in time, serial measurements must be compared to determine whether Periodontitis is progressive. Periodontal probing may be performed manually or by using controlled forceelectronic instruments. The resolution, depending on the instrument, will vary from 1.0 mm to 0.1 mm. Variations in probing force, size and shape of tip, location of tip placement, detection or reference landmarks for attachment level probing, degree of gingival inflammation, and transcription may adversely influence accuracy. Electronic probes offer the advantage of improved resolution, forcecontrol, and automatic recording, but the literature is inconsistent about the advantages in terms of repeatability and accuracy. Radiographic assessment of alveolar bone loss may be achieved by visual interpretation, measurement, or digital image analysis. While visual interpretation of unstandardized radiographs is insensitive to changes in bone, standardized radiographs can permit measurement ofchanges on the order of 0.2 mm when computerized methods are used. Newer techniques such as digital subtraction radiography permit detection of bony changes too small to be seen by the unaided eye and are

95% sensitive and specific in detecting bony changes less than 10 mg. Ann Periodontol 1997;2:113-122.
over

Words: Periodontal probes; bone bone loss/radiography; periodontal attachment;periodontal diseases/

loss/diagnosis;

Key

radiography; periodontal diseases/diagnosis.
Tests

for

grouped into four general categories based on what is used as an indicator of periodontal disease.1 The first group of tests relies on microbiologic assessment of plaque for the
bacteria species related diseases. The second examines metabolic indicators of ingroup flammation and tissuedestruction from the periodontium and gingival crevicular fluid. The third group attempts to identify characteristics of a susceptible or immunocompromised host as they relate to periodontal destruction. The last group uses physical measurement of the support structures of the teeth (Table 1). Periodontal probing and attachment level measurements together with dental radiography are the most commonforms of physical measurement of periodontal support utilized in clinical trials. Probing and radiographic measurements are the most widely accepted and validated methods at this time. The hallmark of Periodontitis is the destruction of the supporting structures of the teeth and the physical measurements are ideally suited to assess these anatomic changes in the periodon-

periodontaldisease may be

putative pathogenic to the periodontal

Vol. 2, No. 1, March 1997

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Reddy

Table 1. Four

general categories of tests for periodontal
diseases

Category Category Category

1
•

=

Microbiologic assessment

Category

•

Identification of infection with pathogenic bacteria 2 Tissue breakdown assessment Indicators of tissue destruction and inflammation 3Host assessment Identification of host site characteristics or risk factors 4 Physical assessment Anatomical measurement of tooth site support
= • =

•

=

Table 2. Uses of
Disease
• •

physical

measurements in clinical

trials

screening Identify subjects with attachment loss and probing depth Include subjects with demonstrable bone loss Formulate a clinical diagnosis Disease...