Robert F Baima

A periodontal examination should provide information regarding the status of bacterial accumulation, the response of the host tissues, and the degree of irreversible damage. Because long-term periodontal health is essential to successful fixed prosthodontics (see Chapter 5), existing periodontal disease must be corrected before any definitive prosthodontic treatment is undertaken.

Gingiva. The gingiva should be lightly dried before examination so that moisture does not obscure subtle changes or detail. Color, texture, size, contour, consistency, and position are noted and recorded. The gingiva is then carefully palpated to express any exudate or pus that may be present in the sulcular area.

Prosthodontic Temporal

Fig. 1-12. Palpation sites for assessing muscle tenderness. A, TMJ capsule: lateral and dorsal. B, Mas-seter: deep and superficial. C, Temporal: anterior and posterior. D, Vertex. E, Neck: nape and base. F, Stern ocleidomastoid: insertion, body, and origin. G, Medial pterygoid. H, Posterior digastric. 1, Temporal tendon. J, Lateral pterygoid.

(From Ki h-Pouf N WG, Olsson A: Dent Clin North Am 10:627,1966.)

Fig. 1-12. Palpation sites for assessing muscle tenderness. A, TMJ capsule: lateral and dorsal. B, Mas-seter: deep and superficial. C, Temporal: anterior and posterior. D, Vertex. E, Neck: nape and base. F, Stern ocleidomastoid: insertion, body, and origin. G, Medial pterygoid. H, Posterior digastric. 1, Temporal tendon. J, Lateral pterygoid.

(From Ki h-Pouf N WG, Olsson A: Dent Clin North Am 10:627,1966.)

Fig. 1-13. Smile analysis is an important part of the examination, particularly when anterior crowns or FPDs are being considered. A, Some individuals show considerable gingival tissue during an exaggerated smile. B, Others may not show the gingival margins of even the central incisors.
Olsson Knife
Fig. 1-14. The "negative" space between the maxillary and mandibular teeth is assessed during the examination.

Healthy gingiva (Fig. 1-15, A) is pink, stippled, and firmly bound to the underlying connective tissue. The gingival margin is knife-edged, and sharply pointed papillae fill the interproximal spaces. Any deviation from these findings should be noted. With the development of chronic marginal gingivitis (Fig. 1-15, B), the gingiva becomes enlarged and bulbous, loss of stippling occurs, the margins and papillae are blunted, and bleeding and exudate are observed.

The width of the band of attached keratinized gingiva around each tooth may be assessed by measuring the surface band of keratinized tissue in an apicocoronal dimension with a periodontal probe and subtracting the measurement of the sulcus depth. Another method to obtain this measurement by visual examination is to gently depress the marginal gingiva with the side of a periodontal probe or explorer. At the mucogingival junction (MGJ), the effect of the instrument will be seen to end abruptly, indicating the transition from tightly bound gingiva to more flexible mucosa. Injecting anesthetic solu

Knife Edged Margin
Fig. 1-15. A, Healthy gingivae-pink, knife-edged, and firmly attached. B, Gingivitis-plaque and calculus have caused marginal inflammation, with changes in color, contour, and consistency of the free gingival margin. Inflammation extends into the keratinized attached gingiva.
Contour Gingiva
Fig. 1-16. A, Three types of sulcus/pocket-measuring probes. B, Correct position of a periodontal probe in the interproximal sulcular area, parallel to the root surface and in a vertical direction as far in-terproximally as possible.

tion into the nonkeratinized mucosa close to the MGJ to make the mucosa balloon slightly is a third method of visualizing the MGJ. However, this is done only if the other methods do not provide the desired information.

Periodontium. The periodontal probe (Fig. 1-16, A) is one of the most reliable and useful diagnostic tools available for examining the peri-odontium. It provides a measurement (in millimeters) of the depth of periodontal pockets and healthy gingival sulci on all surfaces of each tooth. In this examination the probe is inserted essentially parallel to the tooth and is "walked" circumferen-tially through the sulcus in firm but gentle steps, determining the measurement when the probe is in contact with the apical portion of the sulcus (Fig. 116, B). Thus any sudden change in the attachment level can be detected. The probe may also be angled slightly (5 to 10 degrees) in the interproximal areas to reveal the topography of an existing lesion. Probing depths (usually six per tooth) are recorded on a periodontal chart (Fig. 1-17), which also contains other data pertinent to the periodontal examination (e.g., tooth mobility or malposition, open or deficient contact areas, inconsistent marginal ridge heights, missing or impacted teeth, areas of inadequate attached keratinized gingiva, gingival reces sion, furcation involvements, and malpositioned frenum attachments).

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