Summarize the following text to main points and sub-points and make detailed explain for them:

 radiographic assessment 
Conventional radiograph: it is a traditional method used to assess the destruction of alveolar 
bone. It is very speci*ic but lacks sensitivity. 
Problems associated with conventional radiograph 
• Variations in the projection geometry. 
• Variations in contrast and density due to differences in *ilm processing, voltage and 
exposure time. 
• Masking of osseous changes by other anatomic structures.
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Digital radiograph (D.R.): 
 It enables the use of computerized image which can be stored and manipulated. 
Advantages: digital storage, image enhancement, and radiation dose reduction 
Two D.R. systems:   -Direct method        -Indirect method 
Direct method: used charged coupled device, sensor linked with *iber optic to computer 
system. It provides 1/3 -1/2 reduction in radiation dose. 
- hard sensor
- Flexible film like
- Linked with wire
- wireless
- Can't use with anatomical
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Can use
variations
Indirect method: used phosphor luminescence plate which is *lexible, *ilm like radiation 
energy sensor placed intraorally and exposed to conventional X-ray tube, a laser scanner 
read the exposed plate and produce digital image. 
Cone Beam Computed Tomography (CBCT): 
Utilizes a cone shaped source of radiation and an area detector and that it acquires a full 
volume of images in a single rotation with no need for patient movement. CBCT system 
accompanying software, any number of diagnostic images can be generated.
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Advances in Microbiologic Analysis 
Red complex? 
Uses of microbiologic analysis; 
•Support diagnosis 
•Aid in treatment planning 
•Good indicator of disease activity
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Culture techniques have been the primary method of identifying putative pathogens.  
It allows: 
•Characterizing subgingival *lora [count (relative and absolute), and morphology]. 
•For speciation and antibiotic susceptibility testing. 
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Limitation of cultures: 
1-Technical problems, Culture methods can only grow live bacteria; 
therefore, strict sampling and transport conditions are essential.  
2-Cultivating micro-organisms can be both time consuming and costs. 
3-Low sensitivity.
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=> due to Presence of normal flora
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Advances in characterizing host response 
Source of the sample include blood serum, saliva and GCF (gingival crevicular *luid), gingival 
crevicular cells, blood cells and urine. 
Identi7ication of host constituent in crevicular 7luid 
These constituent in GCF may be harvested through: 
• Filter paper or strips 
• Capillary tube includes micropapillary tube, micropipettes, microsyringes 
• Intrasulcus washing 
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The most widely method used for collection of GCF is paper strips. These strips are 
placed in the gingival sulcus for a standard period of time until the *ilter paper is 
saturated, the *luid volume collected on the strips can be then quanti*ied in a number 
of ways.  
At present the most popular way with speci*ic assay is using the Periotron® device. 
The Periotron® measure the capacitance across the wet paper strip, which convert to 
digital reading.  
Periotron® readings have high correlation with clinical gingival indices and its 
quickest and easiest way to measure GCF. 
• Gingival Crevicular Fluid (GCF) 
                                    Methods of collection 
• Gingival Crevicular Fluid (GCF) 
• Periotron® 
The diagnostic markers in GCF are:  three main groups: host-derived 
enzymes, tissue breakdown products, and in7lammatory mediators. 
Concentration of these mediators in GCF from a disease sites may be higher 
than from a healthy sites.
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- In7lammatory Mediators and Products 
IL-1, IL-6, and TNF-a are cytokines produced by a variety of cells at in*lamed sites.  
They are potent immunoregulatory molecules with a variety of biologic effects, 
including metalloproteinase stimulation and bone resorption; therefore, they seem 
good candidates for markers of disease progression.  
Prostaglandin E2 is a product of the cyclooxygenase pathway of the metabolism of 
arachidonic acid. It is a potent mediator of in*lammation and induces bone resorption. 
In cases of untreated periodontitis, the concentration of prostaglandin E2 found in GCF 
increased during active phases of periodontal destruction.
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-Host-Derived Enzymes 
   
The enzymes that have received the most attention as possible markers of active 
periodontal destruction are aspartate aminotransferase (AST), akaline 
phosphatase, ß-glucuronidase, elastase, cathepsins and matrix 
metalloproteinases.  
Some of these enzymes are released from dead and dying cells of the 
periodontium; some come from polymorphonuclear neutrophils; and others are 
produced by in*lammatory, epithelial, and connective tissue cells at affected sites.
-Tissue Breakdown Products 
 One of the major features of periodontitis is the destruction of collagen and 
extracellular matrices.  
Analysis of GCF obtained from sites with periodontitis clearly shows elevated 
levels of hydroxyproline from collagen breakdown and glycosaminoglycans from 
matrix degradation.
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•Thank you


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