After PSR, if a score of 3 is given to two or more sextants, or if a score of 4 is given to a sextant, a full periodontal charting will be necessary. During periodontal charting, a number of factors are measured including recession, pocket depth, bleeding, suppuration, furcation involvement, mobility, clinical attachment loss.
Review Questions on Periodontal charting
What does periodontal charting include?
Gingival Recession
For gingival recession, it is measured the distance to the tip of the gingival margin is away from the cementoenamel junction.
In a healthy person the gingival margin is above the CEJ and hides it, nothing is recorded. When determining CAL, 3mm is taken away.
If the gingival margin is at the CEJ, the recession is marked as 0. In this case, CAL is the same as PD.
If the gingival margin is significantly coronal to the CEJ due to enlargement, GR is recorded as a negative value. This is frequently accompanied by redness and swelling
Probing Depths
Probing depth measures the distance from the gingival margin to pocket to the nearest mm, at six points.
Distal interproximal on the buccal side
Mid-buccal
Mesial interproximal on the buccal side
Distal interproximal on the lingual/ palatal side
Mid-lingual/ Mid-palatal
Mesial interproximal on the lingual/ palatal side
For probing depth, the probe should be angled at 10 – 15 degrees, and light force should be applied until light resistance is felt.
Clinical Attachment Loss
CAL provides an estimation of the true periodontal support and is used for monitoring changes in periodontal support over time. CAL is easily measured when CEJ is exposed/ visible. Clinical attachment loss is a way of determining the severity of the periodontal disease.
CAL = Probing Depth (mm) + Gingival Recession (mm)
In mild cases, the clinical attachment loss is 1 – 2 mm.
In moderate cases, the clinical attachment loss is 3 – 4 mm.
In severe cases, the clinical attachment loss is more than 5mm.
Tooth Mobility
Horizontal tooth mobility should be determined using the backs of two single-ended instruments (e.g. mouth mirror and probe). Fixed reference point should be selected (e.g. adjacent tooth that is not mobile) and pressure should be applied in horizontal buccal-oral direction to the tooth we are testing.
Class I: detectable horizontal mobility up to 1mm in the facial-lingual direction
Class II: detectable horizontal mobility more than 1mm in the facial-lingual direction
Class III: besides detectable mobility in horizontal direction and can move with normal lip and tongue pressure, detection significant vertical mobility (greater than 1mm) causing the tooth to be depressible in the socket
Review questions
What are the classes for tooth mobility?
Bony Defects
Bony defects can be generally classified as suprabony, infra-bony or inter-radicular. Within each category are smaller sub-categories.
Supra-bony "Horizontal" Defects
Supra-bony defects are concerning
Infra-bony "Vertical" Defects
Infra-bony "vertical" defects can be characterised as one of three types of defects.
One walled defects appears the most translucent under bitewing.
Two walled defects appears more translucent that the one walled defected.
Three walled defects appear the least translucent under bitewings.
Inter-radicular Defects
The progress of inflammatory periodontal disease results in attachment loss to affect the bifurcation or trifurcation of multi-rooted teeth. The greater the furcation involvement, the greater the overall risk. Furcation invasions can horizontal or vertical, and is defected using a Naber's probe in the buccal surface of the molars, as well as the distopalatal side.
Horizontal Furcation
Class 0 – None. No furcation involvement
Class I – Early (0-3mm). The furcation can be felt as a groove or curvature, but it cannot enter the space. There is not yet bone loss.
Class II – Moderate (>3mm). Probe penetrates the furcation but does not completely pass through to the other side. The furcation can be probed two or millimetres horizontally so there is some level of bone loss.
Class III – Advanced or “through and through”. Bone passes completely through the furcation, but the soft tissue still fills the furcation defect. Bone loss extends from one side of the affected root all the way through to the other
Class IV – Probe passes completely through the furcation and the entrance to the furcation is clinically visible because of gingival recession.
Vertical Furcation
Subclass A (0 - 3 mm)
Subclass B (4 - 6 mm)
Subclass C (more than or equal to 7mm)
Overall teeth with furcation involvement have poorer outcomes. There is also an increased risk of further attachment loss during supportive periodontal therapy.
Review questions on furcation
What are the classes for Furcation involvements?
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