L15 Periodontal Evaluation

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  • Periodontal Evaluation

    Fanni Kusuma Djati

    Unsoed, 06 Mei 2015

  • Tujuan Pembelajaran

    Menjelaskan cara melakukan evaluasi jaringan periodontal untuk menetapkan diagnosis

  • Referensi

    Armitage, G.C., 2004, The Complete Periodontal

    Examination, periodontology 2000, 34: 22-33.

    Balanoff, W.L., Duval, C., The Role of Technology in

    Periodontal Evaluation and Treatment Acceptance.

    The American Academy of Periodontology, 2011,

    Comprehensive Periodontal Therapy: A Statement by

    The American Academy of Periodontology, Journal of

    Periodontology, 82(7):943-949.

    The American Academy of Periodontology, 2012, Your

    Annual Comprehensive Periodontal Evaluation (CPE), AAP Patient Page melalui www.perio.org.

  • Periodontal Evaluation

  • Periodontal Evaluation

    Penilaian komprehensif keadaan terkini dari pasien meliputi:

    Status kesehatan

    riwayat penyakit

    faktor resiko

    penting untuk mendeterminasi diagnosis dan prognosis periodontal dari gigi-geligi dan/atau

    kesesuaian implant gigi.

  • Periodontal Evaluation

    keluhan utama

    review riwayat medis dan dental

    pemeriksaan klinis

    analisis radiografik

    Pemeriksaan mikrobiologi, genetik, biokimia atau uji diagnostik lain

  • Comprehensive Periodontal Evaluation

    Extra and intraoral examination

    Deteksi penyakit atau kondisi non periodontal

    Examination of teeth and dental implant

    Evaluasi gingiva & struktur terkait, mengukur kedalaman probing, lebar jar.terkeratinisasi, resesi gingiva, attachment level, evaluasi kesehatan area subgingiva dengan mengukur BOP & supurasi, furkasi

    Plak, calculus, inflamasi gingiva

    Dental examination

    Karies, kotak proksimal, restorasi, protesa

    Ocllusal examination

    Radiograf

    Periodontal-penyakit sistemik

    Determinasi faktor resioko

    Umur, diabetes, merokok, CVD

  • SECOND APPOINTMENT

  • Second Appointment

    Oral examination

    Examination of the teeth

    Examination of the periodontium

  • ORAL EXAMINATION

    Kebersihan Mulut

    Bau Mulut

    Pemeriksaan rongga mulut secara keseluruhan

    Pemeriksaan Limfonodus

  • EXAMINATION OF TEETH

    Adanya karies gigi

    Kelainan pertumbuhan dan perkembangan

    Anomali gigi

    Adanya Erosi, Abrasi, Atrisi

    Stain pada gigi

    Hipersensitif

    Hubungan kontak proksimal gigi

    Mobilitas Gigi

    Trauma Oklusi Abfraksi

    Migrasi gigi patologis

  • EXAMINATION OF PERIODONTIUM

    Pemeriksaan Plaque dan Calculus

    Pemeriksaan Gingiva

    warna, ukuran, kontur, konsistensi, tekstur permukaan, posisi

    Nyeri tekan, nyeri raba, bleeding

    Pemeriksaan Periodontal

  • Pemeriksaan Plaque dan Calculus

    untuk memeriksa adanya plaque/kalkulus supragingiva

    Observasi

    untuk memeriksa adanya kalkulus subgingival

    Explorasi dgn explorer

    menyibakkan gingiva. Hembusan

    udara hangat

  • Pemeriksaan Plaque dan Calculus

    EXPLORER UNTUK KALKULUS

    SUPRAGINGIVAL

    EXPLORER UNTUK KALKULUS SUBGINGIVAL

  • Teknik Pemeriksaan Plaque dan Calculus

  • Pemeriksaan Gingiva

    PRINSIP: Gingiva harus dalam keadaan kering.

    1. Observasional

    Perubahan pd ......

    BOP

    distribusi, perluasan penyakit gingiva

    sifat : akut vs kronis

    2. Explorasi

    3. Palpasi

    dilakukan dgn mantap tetapi lembut

    untuk mengetahui lokasi pembentukan pus

  • Pemeriksaan Gingiva

  • Palpasi

    untuk melihat adanya supurasi

    Palpasi menggunakan jari telunjuk

    Beri tekanan dgn gerakan memutar ke arah koronal

  • Pemeriksaan Periodontal

    Poket di setiap permukaan gigi

    Kedalaman poket

    tipe poket

    level perlekatan gingiva ke akar gigi

  • Deteksi Poket

    Periodontal probes (left to right): Williams Graduated, CPITN, UNC-15, Goldman Fox, Nabers.

  • Deteksi Poket

  • Deteksi Poket

    Computer-Assisted Probe.

    This is an example of a computer-assisted

    probe. The probe is connected to a computer

    unit that will store information on recession,

    pocket depth, furcation involvement, and

    mobility. (Photograph, courtesy of Florida Probe

    Corporation.)

  • Probe

  • Tehnik PROBING

  • Tehnik PROBING

  • Tehnik PROBING

    The probe should be inserted PARALLEL TO THE VERTICAL AXIS OF THE TOOTH and walked CIRCUMFERENTIALLY around each surface of each tooth to detect the areas of deepest penetration.

    The probe is not removed from sulcus with each upward stroke

  • The Walking Stroke

    The walking stroke is a series of bobbing strokes along the junctional epithelium (JE).

    Each up-and-down stroke should be approximately 1 to 2 mm in length ().

    The strokes must be very close together, about 1 mm apart ().

    GM, gingival margin.

  • ADAPTATION

    The side of the probe tip should be kept in contact with the tooth surface. The PROBE TIP is defined the side of the probe.

  • PARALLELISM

    The probe is positioned AS PARALLEL AS POSSIBLE TO THE TOOTH SURFACE. The probe must be parallel in the mesiodistal dimension and faciolingual dimension.

  • INTERPROXIMAL TECHNIQUE

    When two adjacent teeth area in contact, A SPECIAL TECHNIQUE IS USED TO PROBE THE AREA DIRECTLY BENEATH THE CONTACT AREA

    Position the probe with the tip in contact with the proximal surface. While maintaining the tip in contact with the tooth surface, walk in between the teeth until it touches the contact area. The area beneath the contact area cannot be probed directly because the probe will not fit between the contact areas of the adjacent teeth.

    Slant the probe slightly so that the tip reaches under the contact area. The tip of the probe extends under the contact area while the upper portion touches the contact area. With the probe in this position, gently press downward to touch the junctional epithelium.

  • EXPLORING

    Exploring with periodontal probe (left) may not detect furcation involvement; specially designed instrument (Nabers probe (right) can enter the furcation area.

  • RULES ON PROBING

    Lakukan di semua gigi.

    Lakukan probing pada 6 permukaan setiap gigi.

    ambil yang paling dalam

    Hanya 1 pembacaan dari setiap permukaan

    4,5 mm dianggap 5mm 2,5 mm dianggap 3 mm

    Tidak ada hasil pengukuran yg tidak genap.

  • RULES ON PROBING

    Probing depth measurements are recorded for 6 specific sites on each tooth:

    1distofacial line angle to the midline of distal surface

    2facial surface

    3mesiofacial line angle to the midline of mesial surface

    4distolingual line angle to the midline of distal surface

    5lingual surface

    6mesiolingual line angle to the midline of mesial surface

  • Kedalaman Poket

    Biological Pocket (A)

    Probing pocket (B)

  • LEVEL OF ATTACHMENT

    Jarak antara dasar poket - CEJ

    Digunakan untuk menunjukkan loss of attachment

    The probing depth

    level of the gingival margin

    (jarak antara gingival margin

    dengan CEJ)

    clinical attachment level

  • LEVEL OF ATTACHMENT

    When the gingival margin is at the CEJ, no calculations are needed because the probing depth and the clinical attachment level are equal.

    For example:

    Probing depth measurement: 6 mm

    Gingival margin level : 0 mm

    Clinical attachment loss : 6 mm

  • BLEEDING ON PROBING

    Masukkan probe hingga ke dasar poket.

    Gerakkan perlahan ke arah lateral di sepanjang dinding poket

    Keluarkan probe dari poket

    Tunggu beberapa detik

    Lihat perdarahan yg terjadi bisa merembes/deras

    BOP akan menentukan apakah lesi bersifat aktif / inaktif

  • LEBAR ATTACHED GINGIVA

    jarak antara mucogingival junction hingga proyeksi dasar poket pada permukaan eksternal gingiva

  • DERAJAT RESESI GINGIVA

  • DERAJAT RESESI GINGIVA

    Diukur menggunakan probe.

    Jarak dari CEJ puncak gingiva margin

  • HILANGNYA TULANG ALVEOLAR

    Lebih nyaman bagi pasien jika sudah teranestesi

    Ketinggian dan kontur tulang fasial dan lingual

    Bangunan tulang interdental

    Probe dapat digunakan untuk mengetahui:

  • PEMERIKSAAN RADIOGRAFI

    Kerusakan Tulang pada penyakit periodontal, meliputi :

    Amount Distribution

    Bone loss

    Horizontal Vertical / angular

    Pattern of bone destruction

  • ...becarefull....

  • PEMERIKSAAN PENUNJANG LAIN

    Status Gizi

    Pasien dengan diet khusus karena alasan medis

    Tes Darah

  • ....review.....

    PERIODONTAL ABSES GINGIVAL ABSES PERIAPIKAL ABSES

    AKUT KRONIS

    KLINIS :

    Gingiva memerah,

    edema, lunak,

    mengkilat, pus keluar

    dr gingiva margin

    KLINIS:

    -Sinus di mukosa

    gingiva

    -Sinus ditutupi oleh

    jar.granulasi wrn pink

    KLINIS:

    -Lokasi di area non

    gingivitis

    -Respon inflamasi

    akut thd benda asing

    KLINIS:

    -Pada gigi non vital

    SIMPTOM:

    -Nyeri Menyebar

    - Gigi goyah

    - Nyeri pada gigi

    dan gingiva saat

    palpasi

    -limfadenitis