ASSIGNMENT: Study the following.

We will have a graded recitation and discussion next

meeting. Individual written assignments will be submitted and graded accordingly.
(Answers should be handwritten). I. Answer the following questions:
1. How do you measure the width of attached gingiva?

-​ Formula: Calculate the width of the attached gingiva by subtracting the probing
depth from the total width of the gingiva.

Step 1: Measure the total width of the gingiva from the gingival margin to the
mucogingival junction

Step 2: Measure the probing depth (from the gingival margin to the base of the
pocket)

Step 3: Subtract the probing depth from the total width of the gingiva to compute
the width of the attached gingiva.

( CHPT13_Foundations of periodontics for the dental hygenist.pdf)

-​ Stretch the lip/cheek to demarcate the mucogingival line while pocket is being
probed. Measure the total width of gingiva (gingival margin to mucogingival line)
and subtract the sulcus/pocket depth from it to determine width of attached
gingiva.

-​

2. How do you measure the thickness of gingiva?

-​ The other dimension that may play a significant role in the maintenance of the
periodontal health is the thickness of the gingiva. Gingival phenotype or biotype has
been classified by Eger and Muller into thick and thin or Class I, IIA and IIB. Thick
gingival phenotype seems to be more conducive to periodontal health. A thin
phenotype predisposes to gingival recession and increased tendency to gingival
inflammation (Fig. 1.4).
-​ Measurement of thickness of gingiva
Earlier the thickness of gingiva were measured using traumatic techniques like
probes and injection needle. But now it can be measured atraumatically using the
newer ultrasonic device called ‘KRUPP SDM’. This uses a pulse echo principle.
With the aid of a pulse generator and a measurement frequency of 5 MHz, a piezo
crystal is allowed to oscillate. Ultrasonic pulses are transmitted at an interval
through the sound permeable gingiva. When it reaches the bone or tooth surface its
starts being reflected due to difference in acoustic impedence. A transducer probe of
4mm diameter is moistened with saliva and applied to the measurement site with
slight pressure to produce acoustic coupling. By timing the received echo with
respect to transmission of pulse, the thickness of mucosa is determined within
seconds and is digitally displayed with a resolution of 0.1mm.
 -​
3. How do you diagnose abnormal frenum?
-​ Tension test is done to detect any abnormal frenum attachment
-​
4. How do you measure gingival recession?
-​ It is recorded during periodontal probing as the distance of the free gingival margin
to the cementoenamel junction. In 1985,
-​ Miller classified marginal tissue recession into four classes:
Class I : Marginal tissue recession not extending to the mucogingival junction. No
loss of interdental bone/soft tissue.
Class II : Marginal tissue recession extends to or beyond the mucogingival junction.
No loss of interdental bone/soft tissue.
Class III : Marginal tissue recession extends to or beyond the mucogingival
junction. Loss of interdental bone/soft tissue or there is malpositioning of the tooth.
Class IV : Marginal tissue recession extends beyond the mucogingival junction. Loss
of interdental bone and soft tissue loss interdentally and/or severe tooth malposition

5. How do you check for bleeding on probing?

-​ The insertion of a probe to the bottom of the pocket elicits bleeding if the gingiva is
inflamed and the pocket epithelium is atrophic or ulcerated. Bleeding on probing is
an earlier sign of inflammation than gingival color changes. To test for bleeding
after probing, the probe is carefully introduced to the bottom of the pocket and
gently moved laterally

6. How do you measure tooth mobility?

-​ Mobility is recorded by moving the teeth in a buccolingual and occlusoapical
direction between the blunt handle ends of two instruments or between the finger
and instrument handle.
-​
7. How do you measure the probing depth?
-​ The only accurate method of detecting and measuring periodontal pocket is careful
exploration with a periodontal probe.
-​ Periodontal probing is done on all surfaces of every tooth in the dentition. Pockets
are not detected by radiographic examination.
-​ The probe should be inserted parallel to the vertical axis of the tooth and "walked"
circumferentially around each surface of each tooth without taking out the probe
completely from the gingival sulcus to detect the areas of deepest penetration
-​
8. How do you measure clinical attachment loss?
-​ Calculation of CAL in different situations.
-​ A. When gingival margin is below CEJ (Clinical gingival recession).
Clinical attachment loss is calculated by ADDING the probing depth
(Y) to the distance between CEJ and gingival margin (X).
-​ B. When gingival margin cover the CEJ, locating on anatomic crown.
Clinical attachment loss is calculated by SUBSTRACTING the
probing depth (Y) to the distance between CEJ and gingival margin (X).
9. How do you measure alveolar bone loss?
-​ Alveolar bone loss: It is evaluated by clinical andradiographic examination. Bone
sounding is done by anaesthetizing the tissue locally and inserting probe
horizontally and walking along the tissue tooth interface, so that the operator can
feel the bony topography. It gives three-dimensional information regarding bone
contour.
-​ It is also called as transgingival probing. It helps to determine the height and
contour of facial and lingual bone; the architecture of the interdental bone; the
extent and configuration of intrabony component of the pocket

10. How do you measure furcation lesions?

-​ Furcation lesion: The furcation lesions can be determined by Cowhorn explorer or
Naber’s probe. The probe is directed beneath the gingival margin. At the base of
pocket, rotate the probe tip toward the tooth to fit the tip into the entrance of the
furcation (Fig. 30.26).
-​ Terminal shank of Naber’s probe is positioned parallel to the long axis of tooth
surface being examined. Distal furcation of maxillary molar can be probed from
either buccal or palatal aspect but mesial furcation of maxillary molar is easily
probed from the palatal aspect.
-​ Radiographs are useful in assessing root morphology and apicocoronal position of
the furcation but do not allow the clinician to determine attachment loss in the
furcation. It appears that radiographs alone do not detect the furcation lesion with
any predictable accuracy and that probing the furcation areas is necessary to
confirm the presence and severity of furcation defect.
-​ In 1953, Glickman classified furcation defect into four grades.
Grade I : It is the incipient stage of furcation involvement, but radiographically
changes are not usually found.
Grade II : The furcation lesion is a cul-de-sac with a definite horizontal component.
Radiographs may or may not depict the furcation involvement.
Grade III : The bone is not attached to the dome of the furcation. Class III
furcations display the defect as a radiolucent area in the crotch of the tooth (Fig.
30.27).
Grade IV : The interdental bone is destroyed and soft tissues have receded apically
so that the furcation opening is clinically visible.
-​
II. Radiograph Interpretation
1-3. Identify the following normal anatomical landmarks:
1.​ INTERDENTAL SEPTUM
2.​ LAMINA LUCIDA - radiographic counterpart of Periodontal Ligament Space
3.​ LAMINA DURA - radiographic counterpart of ALVEOLAR BONE
4-5. In the radiograph below, what type of bone loss can be seen? What type of periodontal
disease?
4.​ Bone loss - VERTICAL BONE LOSS
5.​ Periodontal disease - AGGRESSIVE PERIODONTITIS
6-7. In the radiograph below, what type of bone loss can be seen? What type of periodontal
disease?Horizontal bone loss, chronic periodontitis
8-9. Classify the furcation involvement that is seen in the following radiographs
8. CLASS II
9. CLASS IX
https://dentagama.com/news/furcation-defect

10. What is the defect shown by the arrows?

-​ INTERDENTAL CRATER
11. What is the defect seen in this radiograph?
-​ ANGULAR DEFECT