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By Lacey Waldron and Jenna Marino

Educational Goal

For dental hygiene students to be able to verbalize the benefits and disadvantages of digital probing as compared to standard probing.

Objectives

1. Verbalize the purpose of probing.
2. Describe the difference between a non digital probe and a digital probe.
3. Be able to identify the different generations of probes.
4. Evaluate the different kinds of probes based on their pros and cons.




What is Probing?
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Image 1

"Probe is derived from the latin word “Probo” which means “to test' "(Ramachandra et al., 2011).

  • Used primarily to detect and measure periodontal pockets and CAL.
  • Also used to find calculus and measure recession, attached gingiva, sizes of lesions, identify anomalies, furcation involvements, and locate bleeding tendencies.
    (Ramachandra et al., 2011)

Probing comes with its flaws, and the most difficult part of probing to keep consistent is the measurements, due to reading errors.

  • These errors can be caused by anything from the shape of the teeth, calculus on the tooth surface, overhangs, to incorrect angulation of the probe, amount of pressure applied, misreading the measurements, recording the information wrong and more. With all of this room for error, it can be difficult to reproduce measurements the same every time.
    (Ramachandra et al., 2011).

Not every probe is right for every single type of dental practice.
  • Probes are categorized into "Generations".

  • There are 1st, 2nd, 3rd, 4th, and 5th generation probes



"Used for a general dental practice:
First-generation
Second-generation
Used for a dental practice with an interest in periodontics:First-generationSecond-generationThird-generation (if computerization is adequate)
Used for a specialty periodontal practiceand university and research institutions:Second-generationThird-generationFifth-generation"(Ramachandra et al., 2011)
So Why Probe?"The periodontal pocket, one of the definitive signs of periodontal disease, is the most common parameter to be assessed by dental clinicians. One of the more reliable and convenient ways of detecting, measuring, and assessing the status of periodontal disease activity is through the use of periodontal probes. Periodontal probing permits dentists to identify sites with a history of periodontal disease or those at risk for periodontal breakdown" (Ramachandra et al., 2011).


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What is it?
A first generation probe is a standard, manual probe. They come with different working ends and measuring systems to adapt to the use required of it. There are many types of first generation probes, all with the ultimate purpose of taking a measurement.
How does it work?
The probe is inserted into the gingival sulcus and the clinician manually controls the pressure and depth. When the clinician feels they have reached the base of the sulcus (the Junctional Epithelium), they make note of the depth by observing where the gingival margin lies on the probes working end. The working end is marked or color coded to indicate a measurement in millimeters. The clinician then records the depth for all 6 surfaces of each tooth on the clients chart.
Who is this probe made for?
Everyone. It takes no additional training outside of dental schooling to use, and can be used on any client requiring probing.


Advantages
Disadvantages
  • Inexpensive
  • Requires no additional training
  • Can be used on everyone
  • Potential for Cross-contamination between measuring and recording results
  • Takes longer to complete probing; recording the data is time consuming
  • Requires the use of an assistant to speed up the process
  • Can cause discomfort and pain






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The second-generation (Constant Pressure) instruments are pressure sensitive, allowing for improved standardization of probing pressure


What makes it different?

The second-generation instruments are pressure sensitive, allowing for improved standardization of probing pressure.

How does it work?


This probe has a handpiece and a control base that allows the examiner to control the probing pressure. The pressure is increased until an audio signal indicates that the preset pressure has been reached.
The electronic pressure-sensitive probe, allowing for control of insertion pressure, was introduced in 1980.

Who is this probe made for?


"Second-generation probes can be used in general dental practices, as well as periodontal practices, and do not require computerization in the operatory. The True Pressure Sensitive (TPS) probe is the prototype for second-generation probes. Introduced by Hunter in 1994, these probes have a disposable probing head and a hemispheric probe tip with a diameter of 0.5 mm. A controlled probing pressure of 20 gm is usually applied. These probes have a visual guide and a sliding scale where two indicator lines meet at a specified pressure"
(Ramachandra et al., 2011).

Advantages

  • Standardization of probing forces
  • Comfortable to the patient
  • Constant pressure

Disadvantages

  • Probe tip may pass behind junctional epithelium in inflamed sites
  • Reading has to be preformed manually, an assistant is needed to record the number on the clients chart
  • No computer storage of data



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Second generation probes were a step in the right direction, but the third generation probes were designed to making probing even more accurate still, by digitizing the measurements and storing the data electronically to avoid errors.

PROS:
  • Reduces clinician bias and errors, and allows for more accuracy.
  • Great for periodontists.
  • Many different types of third generation probes, so there is plenty of selection and choice.

CONS:
  • Requires a computerized dental office to work.
  • Expensive $$
  • Requires extra training to becoming proficient in usage


There are 4 main contributors to Third Generation Probes:
The Foster-Miller Probe
The Florida Probe
The Toronto Automated Probe
The InterProbe



The Foster-Miller Probe

  • Was the first of the third generation probes to be designed.
  • Developed in 1986
  • Has controlled probing pressure, and automatically detects the CEJ
    (Ramachandra et al., 2011).


How Does a Foster-Miller Probe Work?
"The ball tip moves or glides over the root surface at a controlled speed and preset pressure. Abrupt changes in the acceleration of the probe movement (recorded on a graph) indicate when it meets the CEJ and when it is stopped at the base of the pocket...the probe tip is extended into the pocket and automatically refracted when the base of the pocket is reached" (Ramachandra et al., 2011).


Advantages:
Automatically detects the CEJ, which is the best
landmark because the location of the CEJ never changes.
Disadvantages:Can misinterpret abnormalities and roughnesson the root surface as the CEJ, leading to a false recording.



The Florida Probe












http://www.youtube.com/watch?v=40BOFJG5WQI

What is it?
  • Florida Probe 2.jpg
    Image 5
    Designed in 1988
  • Combines a probe hand piece, a foot switch, and a computer
  • Controlled Pressure
How Does It Work?
  • "Constant probing pressure of 15 gm is provided by coil springs inside the hand piece. The edge of the sleeve is the reference from which measurements are made, and the probe has Williams' markings; however, actual measurement of the pocket depth is made electronically and transferred automatically to the computer when the foot switch is pressed" (Ramachandra et al., 2011).
Advantages
  • Reduces the possibility of cross-contamination by eliminating the need to record readings by hand
  • Records missing teeth, recession, pocket depth, bleeding, pus, furcations, mobility and plaque.
  • More accurate readings (Within 0.2 mm accuracy) (Ramachandra et al., 2011).
  • Increased client comfort by controlled pressure that can be overridden when necessary
  • Compares previous data from appointments
  • Easier to gain attention of the client, increasing their education.
Disadvantages
  • Underestimating deep probing depths
  • A lack of tactile sensitivity
  • Clinicians need extra training to be able to use the Florida Probe
  • Expensive; office must be computer equipped
Cost
  • $6,500.00 (Karl Schmidt, Florida Probe Representative).

(Ramachandra et al., 2011).

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Florida Probe Software













http://www.youtube.com/watch?list=UU42Y-DBSFAnOIxZKy_X9RiA&v=12THvMP9LDk&feature=player_detailpage#t=147s
Begin watching the video at 2:27 seconds to see how the software works for the Florida Probe.

Florida Probe Website for More Information


The Toronto Automated Probe
  • Created in 1991 at the University of Toronto
  • Uses "occlusoincisal surface to measure relative clinical attachment levels" (Ramachandra et al., 2011)

Advantages
Mercury tilt sensor limits angulation to prevent errors
Incorporated Electronic Guidance System

Disadvantages
Difficulties measuring second and third molars; if the clients head is not positioned in the exact same position, the reading will not be reproduced.

(Ramachandra et al., 2011)



The InterProbe System
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Image 8



What Does it Do?
The InterProbe system is similar to the Florida Probe system, except that it connects to a recording device rather than a computer.

  • The InterProbe also has a flexible tip, which increases the clients comfort by curving with the tooth on insertion.
  • "Stainless steel probes push the gingiva away from the tooth, causing pain, whereas the InterProbe gently slides in" (Ramachandra et al., 2011).
Like other third-generation probes,
the InterProbe has controlled pressure.












Advantages
  • Flexible tip
  • Increased client comfort
  • More accurate readings than a conventional probe
  • REPEATABLE measurements of pockets and attachment loss.

Disadvantages
  • Expensive
  • Requires extra training to use the system
  • Becoming slightly dated with the advanced computerized technology available


InterProbe Website for More Information





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3D Probing Systems are currently still being developed, and there is nothing on the market as of yet



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What is the fifth generation probe?
  • 3D noninvasive design
  • Ultrasound added to fourth generation probe
  • Main objective is to identify attachment level without penetrating the Junctional Epithelium (JE)

"The only fifth-generation probe available, the UltraSonographic (US) probe, uses ultrasound waves to detect, image, and map the upper boundary of the periodontal ligament and its variation over time as an indicator of the presence of periodontal disease. The US probe was devised by Hinders and Companion at the NASA Langley Research Center. This small intraoral probe has an ultrasound beam projection area close enough in size to the width of the periodontal ligament space to give the optimal coupling and small enough to inspect the area between the teeth, while still delivering sufficient signal strength and depth of penetration to image the periodontal ligament space."
(Ramachandra et al., 2011).

How does it work?

To probe these structures ultrasonically, a narrow beam of ultrasonic energy is projected down between the tooth and bone from a transducer, which is scanned manually along the gingival margin. An added virtue of attaining this small a tip size is the ability of the ultrasonic probe to help the clinician examine the area between the teeth, which is where periodontal disease is most likely to occur.
(Ramachandra et al., 2011).

The focused ultrasonic beam is targeted into the pocket in the same way as the insertion of a manual probe Then, the probe is moved along the gingival margin, so the two-dimensional graphical output corresponds to the results a clinician gets from "walking the sulcus" with a manual probe. However, ultrasound gives more information because secondary echoes are recorded from tissue features at various depths. It appears that the technique also will be able to provide information on the condition of the gingival tissue and the quality and extent of the epithelial attachment to the tooth surface. This may supply valuable data to help the clinician in the diagnosis and treatment charting of these diseases.
(Ramachandra et al., 2011).

Advantages

  • A noninvasive probe that provides painless probing to the client
  • Guarantee of probe not passing beyond the junctional epithelium, as ultrasound waves detect, image and map the upper boundary of of the periodontal ligament
  • Computer storage of data and print out or visuals can be used for patient education
  • Guidance path is predetermined
  • Provides information regarding the condition of the gingival tissues

Disadvantages

  • Expensive
  • Operator needs to understand the images provided by the computer
  • Requires a learning curve and training




CROSSWORD

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(PuzzleMakerMac, 2012.)

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Crossword Answers Here





TEST YOUR KNOWLEDGE

1. What is the main purpose of probing?
2. How are digital probes and conventional probes different? What is the major benefit to a digital probing system?
3. How many generations of probes are currently available?
4. What are the four subcategories of Third Generation probes? What is the main feature of each?
5. What is the main feature of the Fifth Generation probe?
6. After learning the information, in your opinion, which probe is the "best"?



References
FloridaProbe.com. (2012). Florida Probe System. Retrieved July 1, 2012 from
http://www.floridaprobe.com/fpsystem01.htm

Interprobe.com. (2011). Interprobe Periodontal Exam and Charting System. Retrieved July 1, 2012 from
http://www.interprobe.com/

Ramachandra, S.S., Mehta, D.S., Sandesh, N., Baliga, V., & Amarnath, J. (2011). Periodontal probing systems: A review of available equipment. Compendium of Continuing Education in Dentistry, 32(2). [Electronic Version]. Retrieved June 20, 2012 from http://www.dentalaegis.com/cced/2011/03/periodontal-probing-systems-a-review-of-available-equipment

Image References
American Dental Solutions. (2011). Image 6. [Online Image]. Retrieved June 19, 2012 from
http://www.american-dental-solutions.biz/images/FloridaProbe.jpg

Blogspot.com. (2012). Image 1. [Online Image]. Retrieved June 19, 2012 from http://2.bp.blogspot.com/-q1UDemlY7IQ/TbbvHDmS2GI/AAAAAAAAACw/geLEN-ci39c/s1600/probe2.JPG

DentalCompare.com.(2008). Image 5. [Online Image]. Retrieved June 19, 2012 from
http://media.dentalcompare.com/m/25/Article/30_figure1.jpg

DentistryIndia.net. (2009).Image 2. [Online Image]. Retrieved June 19, 2012 from http://www.dentistryindia.net/content/DI/img/2009/05/DI_may_june2009_f4x.jpg

Interprobe.com. (2011). Image 7. [Online Image]. Retrieved June 19, 2012 from
http://www.interprobe.com/standgraphic.jpg

Interprobe.com. (2011). Image 8. [Online Image]. Retrieved June 19, 2012 from
http://www.interprobe.com/mainlogo.jpg

Magu. (2010). Image 4. [Online Image]. Retrieved June 19, 2012 from
http://xn----htbbbqvfyr1b.xn--p1ai/uploads/images/photo_uslugi/florida_proub2.jpg

Dentalageis. (2011). Image 3. [Online Image]. Retrieved June 19, 2012 from
http://www.dentalaegis.com/cced/2011/03/periodontal-probing-systems-a-review-of-available-equipment

PuzzleMakerMac. (2012). Crossword. [Image]

USProbe.com. (2012). Image 9. [Online Image]. Retrieved June 19, 2012 from
http://www.usprobe.com/