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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