NEET MDS Lessons
Periodontology
Naber’s Probe and Furcation Involvement
Furcation involvement is a critical aspect of periodontal disease that affects the prognosis of teeth with multiple roots. Naber’s probe is a specialized instrument designed to assess furcation areas, allowing clinicians to determine the extent of periodontal attachment loss and the condition of the furcation. This lecture will cover the use of Naber’s probe, the classification of furcation involvement, and the clinical significance of these classifications.
Naber’s Probe
-
Description: Naber’s probe is a curved, blunt-ended instrument specifically designed for probing furcation areas. Its unique shape allows for horizontal probing, which is essential for accurately assessing the anatomy of multi-rooted teeth.
-
Usage: The probe is inserted horizontally into the furcation area to evaluate the extent of periodontal involvement. The clinician can feel the anatomical fluting between the roots, which aids in determining the classification of furcation involvement.
Classification of Furcation Involvement
Furcation involvement is classified into four main classes using Naber’s probe:
-
Class I:
- Description: The furcation can be probed to a depth of 3 mm.
- Clinical Findings: The probe can feel the anatomical fluting between the roots, but it cannot engage the roof of the furcation.
- Significance: Indicates early furcation involvement with minimal attachment loss.
-
Class II:
- Description: The furcation can be probed to a depth greater than 3 mm, but not through and through.
- Clinical Findings: This class represents a range between Class I and Class III, where there is partial loss of attachment but not complete penetration through the furcation.
- Significance: Indicates moderate furcation involvement that may require intervention.
-
Class III:
- Description: The furcation can be completely probed through and through.
- Clinical Findings: The probe passes from one furcation to the other, indicating significant loss of periodontal support.
- Significance: Represents advanced furcation involvement, often associated with a poor prognosis for the affected tooth.
-
Class III+:
- Description: The probe can go halfway across the tooth.
- Clinical Findings: Similar to Class III, but with partial obstruction or remaining tissue.
- Significance: Indicates severe furcation involvement with a significant loss of attachment.
-
Class IV:
- Description: Clinically, the examiner can see through the furcation.
- Clinical Findings: There is complete loss of tissue covering the furcation, making it visible upon examination.
- Significance: Indicates the most severe form of furcation involvement, often leading to tooth mobility and extraction.
Measurement Technique
- Measurement Reference: Measurements are taken from an imaginary tangent connecting the prominences of the root surfaces of both roots. This provides a consistent reference point for assessing the depth of furcation involvement.
Clinical Significance
-
Prognosis: The classification of furcation involvement is crucial for determining the prognosis of multi-rooted teeth. Higher classes of furcation involvement generally indicate a poorer prognosis and may necessitate more aggressive treatment strategies.
-
Treatment Planning: Understanding the extent of furcation involvement helps clinicians develop appropriate treatment plans, which may include scaling and root planing, surgical intervention, or extraction.
-
Monitoring: Regular assessment of furcation involvement using Naber’s probe can help monitor disease progression and the effectiveness of periodontal therapy.
Iodine Effects
- High dose, short period → Inhibits T4 synthesis (Wolff-Chaikoff effect)
- Low dose, long period → Increases T4 synthesis (Jod-Basedow effect)
Drugs Inhibiting T4→T3 Conversion
Propranolol, Dexamethasone, Propylthiouracil, High-dose iodine, Radiographic contrast
Hypothyroidism
- Best test: Raised TSH (primary hypothyroidism)
- Causes: Amyloidosis, Sarcoidosis, Hemochromatosis, Scleroderma, Cystinosis
- Drugs: Amiodarone, Lithium
- Hashimoto thyroiditis
Platelet-Derived Growth Factor (PDGF)
Platelet-Derived Growth Factor (PDGF) is a crucial glycoprotein involved in various biological processes, particularly in wound healing and tissue repair. Understanding its role and mechanisms can provide insights into its applications in regenerative medicine and periodontal therapy.
Overview of PDGF
-
Definition:
- PDGF is a glycoprotein that plays a significant role in cell growth, proliferation, and differentiation.
-
Source:
- PDGF is carried in the alpha granules of platelets and is released during the process of blood clotting.
-
Discovery:
- It was one of the first growth factors to be described in scientific literature.
- Originally isolated from platelets, PDGF was found to exhibit mitogenic activity specifically in smooth muscle cells.
Functions of PDGF
-
Mitogenic Activity:
- PDGF stimulates the proliferation of various cell types, including:
- Smooth muscle cells
- Fibroblasts
- Endothelial cells
- This mitogenic activity is essential for tissue repair and regeneration.
- PDGF stimulates the proliferation of various cell types, including:
-
Role in Wound Healing:
- PDGF is released at the site of injury and plays a critical role in:
- Promoting cell migration to the wound site.
- Stimulating the formation of new blood vessels (angiogenesis).
- Enhancing the synthesis of extracellular matrix components, which are vital for tissue structure and integrity.
- PDGF is released at the site of injury and plays a critical role in:
-
Involvement in Periodontal Healing:
- In periodontal therapy, PDGF can be utilized to enhance healing in periodontal defects and promote regeneration of periodontal tissues.
- It has been studied for its potential in guided tissue regeneration (GTR) and in the treatment of periodontal disease.
Clinical Applications
-
Regenerative Medicine:
- PDGF is being explored in various regenerative medicine
applications, including:
- Bone regeneration
- Soft tissue healing
- Treatment of chronic wounds
- PDGF is being explored in various regenerative medicine
applications, including:
-
Periodontal Therapy:
- PDGF has been incorporated into certain periodontal treatment modalities to enhance healing and regeneration of periodontal tissues.
- It can be used in conjunction with graft materials to improve outcomes in periodontal surgery.
| Feature | Details |
|---|---|
| First valvular lesion | Mitral regurgitation |
| Commonest valve | Mitral (especially in children) |
| Minor criteria | Fever (Modified Jones Criteria) |
| Subcutaneous nodules | Non-tender, extensor surfaces |
| Erythema marginatum | Associated with carditis |
| Diagnostic marker | Aschoff's nodule |
| McCallum's patch | Rheumatic endocarditis indicator |
Systemic Antibiotics
- Most photosensitizing: Doxycycline
- Only one causing tooth discoloration: Minocycline
Local Drug Delivery
- Atridox: Doxycycline
- Arestin: Minocycline
- Elyzol: Metronidazole
- Periochip: Chlorhexidine
- Actisite: Tetracycline
Host Modulation
- SDD (Sub – antimicrobial Dose Doxycycline): Only FDA – approved host modulating agent
Critical Measurements
- PMN threshold: 60% in junctional epithelium → tissue detachment
- Clinical significance: Level 1 provides tangible benefit of large size
Important Ratios & Numbers
- GCF glucose: 3 – 4× serum levels
- Aggressive vs chronic periodontitis: 3 – 4× faster bone loss
- Mineralization timeline: 50% (2 days), 60 – 90% (12 days)
- ANUG Staging:
- Stage 1 – 2: NUG/NUP
- Stage 3 – 4: NUP
- Stage 5 – 6: Necrotizing stomatitis
- Stage 7: Noma
- Bone Defects:
- 3-wall: Intrabony
- 2-wall: Crater
- 1-wall: Hemiseptum
- Radiographic Signs: Fuzziness in lamina dura is earliest sign.
- TFO (Trauma from Occlusion): Widened PDL, thickened lamina dura.
- Most Susceptible Area: Furcation.