Preventive dentistry Soft tissue - mucous membranes, gingiva Indices - PBI, API, CPITN, BOP Oral hygiene Periodontological instruments MUDr. Hana Poskerová Ph.D. Stomatologická klinika FN u svaté Anny a LF MU v Brně Systematic examination of mucosal mucosa • lip - lip red, mouth corners • gingiva • lip, vestibular, bucal and alveolar mucosa • soft and hard palate, palatal arches, uvula • tongue (dorsum, lateral sides, base) • bottom of the oral cavity Free gingiva Attached gingiva Mucogingival line Alveolar mucosa It is needed to protect the neck of the tooth 1 - sufficient width of the connected gingiva (minimum 1-2 mm) 2 - strong (thick) or moderate gingival thickness • Gingival thickness – strong, moderate, thin Shallow lower vestibulum (insufficient width of attached gingiva) Thin gingival phenotype, gingival recession in tooth 41 - consequence of piercing Tooth position in the alveolus: b - thin vestibular lamella b - bone dehiscence vestibularly a b "High frenulum attachment" - pulling - papillary anemization under pressure on the frenulum - movement of the papilla and marginal gingiva under pressure on the frenulum Physiolo- gical Gingival Papillary Passing through the papilla Papilla Bleeding Index • distal papillae / halfpapillae are evaluated • for seven teeth in each quadrant PBI • 0 gingiva without bleeding • 1 point bleeding (spot) • 2 stripe bleeding (line) multipoint bleeding • 3 blood fills interdental space (triangle) • 4 spontaneous bleeding, blood flows to adjacent areas (drop) 0 4 3 2 1 2 48/24 Papilla Bleeding Index • Total value 4  7  (0 - 4) 0 -112 • 4  7  0  0 Very good OH • 4  7  4  112 Bad OH • Index - total value of bleeding papillae / number of examined papilla • Index 0 – 4 • Influence of smoking on PBI !!! 1/ all distal papillas have PBI 2 3rd molares and all lower incisors are missing 48/24 PBI 2 2/ all distal papillas have PBI 3 all lower incisors are missing 72/24 PBI 3 3/ all distal papillas have PBI 1 3rd and 2nd molares are missing 24/24 PBI 1 4/ all upper distal papillas have PBI 3; all lower distal papillas have PBI 2 all molares are missing 50/20 PBI 2,5 Determine the PBI value Example: all distal papillas have PBI 4, all teeth are present: PBI 112/28 index 4 • 4 quadrants • I. and III. quadrant from oral aspect • II. and IV. quadrant from facial aspect • 28 masurement sites in complete dentition API Aproximal Plaque Index API • number of locations with plaque / number of evaluated areas  100 (%) • 28/28  100  100% Bad OH • 0/28  100  0% Very good OH • Good motivation ability + + + + – – – – – – + + + + + + + + – – – – – – + + + + 47 46 45 44 43 42 41 31 32 33 34 35 36 37 17 16 15 14 13 12 11 21 22 23 24 25 26 27 Index API number of locations with plaque / number of evaluated areas  100 (%) API  16 / 28  100  57 % Interdental Hygiene Index HYG • reverse • number of locations without plaque / number of evaluated areas  100 (%) • 28/28  100  100% Very good OH • 0/28  100  0% Bad OH – – – – + + + + + + – – – – – – – – + + + + + + – – – – 47 46 45 44 43 42 41 31 32 33 34 35 36 37 17 16 15 14 13 12 11 21 22 23 24 25 26 27 Index HYG number of locations without plaque / number of evaluated areas  100 (%) API  12 / 28  100  43 % 1/ all distal aproximal areas at molars have a plaque, the others not 8/28 API 28,5 % 2/ all distal aproximal areas at incisors and canines have a plaque, the others not 12/28 API 42,8 % 3/ all distal aproximal areas at molars and premolars have a plaque, the others not 16/28 API 57,1 % 4/ all distal aproximal areas at molars and premolars have a plaque, the others not. 3rd and 2nd molares and 1st premolars are missing 8/20 API 40 % Determine the API value when all teeth are present API number of areas with plaque / number of evaluated areas  100 (%) ∕ + + ∕∕ + + ∕ ∕ + + ∕∕ + + ∕ ∕ + + ∕ Index API CPITN O CPITN OCPITN O - no bleeding - no calculus - probing up to 3,5 mm (without) so probing can be 0.5 mm /1 mm 2 mm /3 mm Probing depth 5,5 mm CPITN 4 Probing depth 3,5 mm CPITN 3 CPITN 0,1,2 - probing depth can be 0.5/1/2/3 mm - no pocket CPITN 3 - probing depth can be 4/5 mm - shallow pocket CPITN 4 - probing depth can be 6/7/8.....mm - deep pocket CPITN Bleeding Calculus Pocket probing depth (in mm) CPITN 1 - - 3 0 2 - - 3,5 3 3 - + 3 2 4 - + 3,5 3 5 + + 3 2 6 + + 3,5 3 7 - - 4 3 8 + + 4 3 9 + - 5,5 4 10 - + 5,5 4 11 - - 8 4 12 + + 8 4 Periodontological instruments • Periodontological probes • Explorers • Instruments and apparatus for supragingival and subgingival treatment • Polishing equipment Periodontal probes and explorers Marquis color coded probe (3-6-9-12) UNC 15, North Carolina perio probe WHO Nabers • Hand instruments Scalers Curettes universal special • Handle • Shank • Working part Instruments for the frontal area - incisors, canines Instruments for the distal area - premolares, molares Scalers Universal curettes Periodontal pocket: - swimming plaque - adherent plaque - subging. calculus - infected layer of cementum - infected inner layer of the gingival wall Universal curette Gracey curette 1/2 3/4 5/6 7/8 9/10 11/12 15/16 13/14 17/18 1/2 3/4 5/6 7/8 9/10 11/12 15/16 13/14 17/18 • Porphyromonas gingivalis • Tannerella forsythia • Treponema denticola Perio PATOGENS • Aggregatibacter (Actinobacillus) actinomycetemcomitans serotyp b • Porphyromonas gingivalis • Tannerella forsythia • Treponema denticola • Prevotella intermedia • Fusobacterium nucleatum • Peptostreptococus micros are able to invad soft tissue of perio pocket Healing – reparation – long junctional epitelium Electronically powered devices • Ultrasonic and sonic instruments developed with the goal making calculus removal easier and faster with less patient discomfort Ultrasonic and sonic instruments Parallel position No pressure With permanent movement Active part only 2 – 4 mm Requires permanent water cooling Infectious spray Comparison of S+U devices × hand instruments • Several mechanisms of action (cavitation effect) • One mechanism (can remove only what it touches) • The pocket is washing out • Some debris remains in pocket • Less time – more time ??? • Light lateral pressure with relaxed grasp × vibrations ! • More presure, hand overload • No sharpening required × tip loss • Must be maintained - regularly sharpening/grinding • Infectious spray (protective equipment) • No at patients with cardiostimulator RDA - the degree of abrasiveness 0 - 70 RDA low abrasive 70 -100 RDA medium abrasive 100-150 RDA highly abrasive Fine abrasive materials for polishing