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

Advances in Periodontal Diagnosis
By Dr. Mohammed Alhakeem 
Dr.Huda jasim 
Department of periodontology  
College Of Dentistry 
University of Basrah
In conventional diagnosis and classi*ication of periodontal disease for a given 
patient primarily we depend on clinical assessment with many factors as 
1. Presence or absence of clinically detectable in*lammation. (gingivitis) 
2. Extent and pattern of clinical attachment loss. (periodontitis) 
3. Patient age at onset. 
4. Rate of progression. 
5. Presence or absence of miscellaneous signs and symptoms including pain, 
ulceration and amount of observable plaque and calculus.
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D
Presence
or absence of
Gingival inflammation
②Patient age at onset of
disease
④Pain and mobilityS
Rate of Progression
To reach a good diagnosis we examine: 
1. Gingival tissue in health and compare with signs of in*lammation. (gingival index, bleeding on 
probing…..etc) 
2. Loss of attachment assessed by probing pocket depth with calibrated instrument. (Periodontal 
probes) 
3. Radiographic evidence of alveolar bone loss. 
4. Demographic data as: age, gender, etc… 
5. Medical history and history of previous and current periodontal problem and miscellaneous 
clinical features or observation.
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Normal Gingiva
Abnormal
-Color Pink
- red or bluish red
- Texture / firm and resilient With
- smooth; it can be fibrotic and tough
stippled
appearance
- Contour scalloped
-Gingival margin being irregular
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Consistency // firm and tightly attach
- soft and easily displaced with loss of
to underlying
bone
firm attachment to underlying bone
- size / not swollen or enlarged
- POP 11 not bleed
- swollen
or enlarged
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Bleed
-Pain / no Pain
- may be Pain
In medical diagnosis, test sensitivity  
is the ability of a test to correctly identify those with the disease (true positive 
rate), whereas test speci*icity is the ability of the test to correctly identify those 
without the disease (true negative rate). 
- low rate
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The sensitivity of a test (also called the true positive rate) is de*ined as the 
proportion of people with the disease who will have a positive result. In other 
words, a highly sensitive test is one that correctly identi*ies patients with a 
disease.  
A test that is 100% sensitive will identify all patients who have the disease. It’s 
extremely rare that any clinical test is 100% sensitive. A test with 90% sensitivity 
will identify 90% of patients who have the disease, but will miss 10% of patients 
who have the disease.
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disease &24/ Patient >195)
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The speci7icity of a test (also called the True Negative Rate) is the proportion of 
people without the disease who will have a negative result.  
In other words, the speci*icity of a test refers to how well a test identi*ies patients 
who do not have a disease. A test that has 100% speci*icity will identify 100% of 
patients who do not have the disease. A test that is 90% speci*ic will identify 90% 
of patients who do not have the disease and will miss 10% of patients who do not 
have the disease.
Low rate test go diseases 15.18
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disease is si
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eg
:X-ray Specific test disease
N. 1JOg
disease /1 +/& J &Dj &
Note:o apical lesion "Bone loss" in RG
Clinical Diagnostic Methods 
1-Gingival bleeding: It's an indicator of in*lammatory lesion but 
its relation to disease activity is not clear yet. The normal force 
applied on probing is 0.25 N.  
Presence of positive bleeding on probing is  
not an indicator but negative bleeding or  
absence of bleeding indicates health.  
(This is in non-smoker patients)                  
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Sensitive test but not highly specific
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↳Forces gilE91145
55 %%1950
·.25tj; 6141
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2-Probing technique 
Controlled – force, standardized probes, the periodontal probe 
is the most widely used periodontal diagnostic tool for 
clinically assessing connective tissue destruction secondary to 
periodontitis.
Marquis color-coded probe
calibrations are in 3 millimeter sections.
Williams probe
 Has both - color 
and C coding 
with markings at 
1,2,3,5,7,8,9 and 
10 mm.
WHO probe: It has a 0.5 - mm ball 
at the tip and millimeter & marking 
at 3.5, 8.5 and 11.5 mm
Michigan “O” probe 
with markings: At 3, 
6,and 8 mm.
Universal  probe
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0 .5
3
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- 2
8. 511
. 5
~
x 8
3
j
9 ,0
j
coded in
5th ; 10th ; 15th
Problems associated with conventional probe 
are: 
1.Probing technique 
2.Force. 
3.Probe diameter and angulations. 
4.Presence of in*lammation
· Type
of
Probe
Advances in Clinical Diagnosis 
1-Indicators of local physical metabolic changes (gingival temperature) 
Subgingival temperature:  Like other signs of in*lammation has good speci*icity but poor 
sensitivity when considered alone as a marker for progressive periodontitis. 
It appears to be an anatomic temperature gradient in the oral cavity where mandibular 
periodontal sites are hotter than maxillary sites, posterior wormer than anterior site.
#
- Mandibular y maxilla
- Post
. ) anterior
disease
(10Y25
.
[
_ /5
Also, it appears that there is positive correlation between elevated 
subgingival temperature and: 
•Severity of disease.(amount of attachment loss) 
•Degree of subgingival in*lammation.it increased at the diseased site due 
to increase in cellular and molecular activity 
•Presence of putative pathogens. 
•Smoking state. smokers have differences in sub gingival temperature 
and sub lingual temperature. 
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note smoking = Vasoconstriction of BV
↓Blood
in subgingival
↓TemperatureI
Sub gingival probe is the tool used for measuring subgingival 
temperature. It is also called the perioTemp.  
probe which detect the difference in the temperature of 0.1c. The warm 
area signaled with red emitted diode. 
2-Periodontal Probes  
A-Pressure sensitive probe (Constant Force Probe): 
 it has a standardized, 
controlled insertion pressure. It uses a fabricated stent for reproducibility. 
-30 gm ! tip with the junctional epithelium. 
-50 gm ! periodontal osseous defect.
↑disadvantage Costed
i Time Consuming
angulation &4 Guide
14051-
one Force
110555-
B- Automated Florida disc periodontal probe:  
which give a certainty of 99% detect of loss of attachment level of less than 1mm.  
It utilizes a reproducible Occlusal landmark or a customized stent margin as a reference land 
mark.  
Its probe hand piece connected to a monitor for digital read out and foot switch all to 
computer. 
 It applied a constant force through a coil spring inside the probe. 
G
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-Advantage: it applied constant force and no need for assistant. 
-Disadvantages: lack of tactile sensitivity, under estimation of deep probing points and *ixed 
probing force.
①
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&costed
Sus bas &1555
16
C-Automated Foster-Miller probe: it registers the C.E.J as its attachment 
level landmark. Some investigations reveal that this probe detect up to 0.2mm 
loss in attachment. It capable of coupling pocket depth with detection of C.E.J. 
-The disadvantage of such probe is time consuming. 
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Advances in 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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"13
. 50
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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, st

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