Measurement of clinical attachment levels using a constant‐force periodontal probe modified to detect the cementoenamel junction

Abstract

The handpiece of a Florida sleeve probe was modified to create a flange with the capability to detect the cemento-enamel junction (CEJ). This new instrument (the Pressure-controlled, Automated, Standardised Handpiece or Florida PASHA probe) was used to determine whether (a) the CEJ could be reproducibly detected in dried, human skulls and (b) clinical attachment levels could be reliably measured in human subjects. When using the Florida PASHA probe to detect the CEJ at 157 different sites in four dried, human skulls, there were no statistically significant (p > or = 0.15) differences in mean CEJ detection measurements for any of the three participating examiners; either when the CEJ was visualised or obscured. The mean differences between first and second replicates ranged from 0.00 to 0.08 mm. Intraclass correlation coefficients (ICCs) of repeated measures in both conditions ranged from 0.70 to 0.83 for tactile CEJ detection (CEJ obscured), and from 0.95 to 0.96 for visual detection (CEJ visible). In human studies, the Florida PASHA probe was used by two examiners to determine clinical attachment levels (CAL) at 660 sites in 5 human subjects undergoing supportive periodontal therapy. Intra-examiner agreement of replicate measurements recorded by the probe, as measured by calculating ICCs, ranged from 0.79 to 0.85 for the 2 examiners, respectively. A statistically significant inter-examiner difference in mean CAL measurements when using the Florida PASHA probe was found (p<0.001). Notwithstanding this difference, inter-examiner agreement was good, with an ICC of 0.83. These data suggest that the Florida PASHA probe can reproducibly detect the CEJ and is proposed as a tool for measuring CAL in humans.

Comparative evaluation of accuracy of periodontal probing depth and attachment levels using a Florida probe versus traditional probes

“…Data demonstrated that the CEJ and Florida probe were more consistent statistically. The result from present study are consistent with those presented by Preshaw et al (1999) 11 and Karpinia et al (2004). 12 Various factors such as probe-tip size, angle of insertion of the probe, probing pressure, precision of probe calibration and degree of inflammation in the underlying periodontal tissues affect the sensitivity and reproducibility of measurements.…”

Accuracy of probing attachment levels using a new computerized cemento-enamel junction probe

“…Clinical probing is one procedure that has been used extensively to assess changes in periodontal attachment over time. [1] Increased precision of periodontal probing is of clinical importance because the reported prevalence of disease activity as identified by clinical attachment level (CAL) change clearly depends on the threshold used for identifying whether the loss of attachment has occurred. [2] Moreover, although CAL should be measured from the base of the pocket to the cemento-enamel junction (CEJ), the detection of this anatomic landmark is usually difficult and not reproducible by standard probing methods.…”

“…For these reasons, it is desirable to measure CAL using the CEJ as the reference point. [1] Recently, a modification of the Florida Probe i.e. CEJ probe was introduced to detect the CEJ and to improve the accuracy and consistency when recording periodontal attachment levels.…”

“…CEJ probe was introduced to detect the CEJ and to improve the accuracy and consistency when recording periodontal attachment levels. [16] The CEJ probe was initially tested by Preshaw et al .,[1] His results indicated that the CEJ probe had reproducibility and reliability in detecting the CEJ in human skulls and measuring CAL in humans. Karpinia et al .…”

The location of cemento enamel junction for CAL measurement: A clinical crisis

“…The Cemento-enamel junction (CEJ) acts as a static landmark to measure CAL or periodontal destruction. [1] Thus, the CEJ is a very important landmark for the periodontist, but various problems are faced while measuring CEJ, as difficulty in probing specially when it is subgingival[2] and it is difficult to detect CEJ if obscured by calculus or dental restorations. [3] Also, the three hard tissues found at the CEJ region are unpredictable and irregular on a single tooth and contra lateral teeth.…”