Modern Methods for Diagnosis of Periodontal Diseases

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Modern Methods for Diagnosis of Periodontal
Diseases

• Antonio J. Moretti, DDS, MS

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Why When Where?
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Models of Disease Activity

• Continuous
• Episodic burst
• Asynchronous multiple burst

Socransky et al., 1984
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Periodontal Forecast
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Use of Diagnostic Tests

• Detect disease presence
• Evaluate severity
• Predict clinical course and prognosis
• Evaluate response to treatment before it starts
• Assess actual response to treatment after its
  completion

McCulloch, 1994
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Clinical Evaluation

• Probing depth/attachment level
• Bleeding on probing
• Tooth mobility
• Lack of keratinized gingiva

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Florida Probe
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Assessment of Alveolar Bone

• Conventional radiographs
• Lamina dura
• Bone metabolism
• Subtraction radiography

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1980
1990
2000
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1980
1990
2000
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Lamina dura
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Subtraction Radiography
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Gold Standard

• Attachment loss gt2mm between two visits

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Statistical Formulas

• Sensitivity
• Number of diseased subjects with a positive test
  divided by the total number of diseased subjects
  tested
• Specificity
• Number of non-diseased subjects with a negative
  test divided by the total number of non-diseased
  subjects tested

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Statistical Formulas

• Positive predictive value
• Number of positive tests in diseased subjects
  divided by the total number of positive tests
• Negative predictive value
• Number of negative tests in diseased subjects
  divided by the total number of negative tests

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Diagnostic Aids

• Temperature assessments
• Microbiologic evaluation
• Immunologic assays
• Biochemical assays

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Temperature Assessment

• Periotemp

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Microbiologic Evaluation

• Culturing
• Microscopic monitoring
• DNA probes

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Immunologic Assays

• ELISA
• Others

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Host Enzymes in GCF

• Alkaline phosphatase
• Aspartate aminotransferase
• Elastase
• Cathepsin-like proteases

• Hyaluronidase
• Lysozyme
• Matrix metalloproteinases (collagenases and
  elastases)

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Criteria for Diagnostic Tests

• Compare with gold standard
• Sensitive to wide spectrum of disease?
• Clinical setting is appropriate?
• Reproducibility evaluated?
• Observer variation measured?
• Is test appropriately responsive to changes
  effected by therapy?
• Evaluation of test with a battery of other
  tests?
• Prognostic value evaluated?

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Future in Periodontal Diagnosis

• Combination of tests rather than one test for one
  single aspect of periodontal disease
• The more we understand the pathogenesis of
  periodontal disease, the higher the chance to
  have more accurate and effective diagnostic tests