Histologic probe position in treated and untreated human periodontal tissues

Abstract

This study was designed to histologically determine the relationship of the periodontal probe tip to the periodontal tissues during probing of untreated periodontal pockets and periodontal pockets treated with oral hygiene and root planing. Human, condemned, single rooted teeth with buccal probing pocket depth at least 6 mm were used. Two groups of specimens were included: 12 untreated teeth from six patients and 15 treated teeth from 10 patients. In the treated group, the effects of therapy were monitored clinically every 2 weeks until maximum improvement had taken place. A periodontal probe tip was then inserted on the buccal aspect of the tooth using 0.50 N pressure, and block section biopsies were taken. The histologic examination of the untreated teeth showed that the probe tip penetrated beyond the apical termination of the junctional epithelium and into the subjacent connective tissue by a mean of 0.45 +/- 0.34 mm, whereas in the treated specimens the probe stopped coronally to this landmark by a mean of 0.73 +/- 0.80 mm. This study demonstrated that the probe tip most often does not reach the base of the junctional epithelium in pockets treated by plaque control and root planing, and that clinical measurements of attachment levels are not reliable in determining the true histologic level of connective tissue attachment.

A clinical and radiographic evaluation of the management of periodontal osseous defects with alloplast and platelet rich plasma

“…Comparison between the two groups revealed no statistically significant difference in the reduction of clinical attachment level when measured at different points of time during the study, in contrast to the study of [22] and Saini et al, (2011) [35] where a statistically significant gain in clinical attachment was reported with PRP in combination with other alloplastic materials, when compared to bone grafts alone [12]. The gain in the clinical attachment level has been thought to represent resolution of tissue inflammation, reformation of collagen fibers, new attachment to the root surface and the bone fill [39]. Thus effectively, both the treatment modalities resulted in a significant reduction in pocket depth and clinical attachment gain.…”

Periodontal Probing

“…At the most apical end of the pocket, the pocket epithelium proceeds seamlessly into the junctional epithelium, which continues to maintain an epithelial attachment of greatly reduced height. The periodontal probe will easily traverse the pocket epithelium and penetrate more or less deeply into the connective tissue, as shown by Listgarten (1980) andFowler et al (1982). The magnitude of tissue penetration will depend on the presence, severity, and extent of inflammation, but usually the probe will be stopped at approximately the level of the dentogingival junction (Listgarten, 1980).…”

Reevaluation of Initial Therapy: When Is the Appropriate Time?

“…When a periodontal probe is inserted into the pocket of a diseased and inflamed pocket, the probe penetrates past the pocket epithelium into the connective tissue, resulting in inaccurate probing depth readings. After scaling and root planing, junctional epithelium is reestablished, and the inflammatory cells in the gingival connective tissue are replaced by collagen, resulting in increased resistance to probing force 25 . The connective tissue was more inflamed adjacent to the junctional epithelium of healed tissue than healthy gingiva that was not inflamed 26 .…”