Technological advances in the clinical diagnosis of periodontal diseases

Traditional diagnostic procedures for periodontal disease, such as probing and radiographic assessment, supply information on previous disease experience but not of present site-specific activity nor of possible future attachment loss. Although the newer automatic probes which record data electronically give higher resolution and accuracy than their manual counterparts, their use in clinical practice is only of value in longitudinal clinical trials. In general clinical practice, manual probing is adequate provided probing technique and probe tine characteristics are within acceptable limits. It is suggested that the general practitioner could use the CPITN method for screening purposes because of its relative speed and ease. This must, however, be supplemented by comprehensive probing in each sextant with advanced disease. The humble bitewing radiograph is likewise adequate for the assessment of alveolar bone loss in normal clinical practice but if refined data of bone loss over time is required, subtraction radiography is recommended. Currently, other forms of imaging technology have limited value in clinical practice because of technical complexity, access and cost. A number of other electronic devices are available which make the accurate assessment of mobility and occlusal function possible but, because the relationship between these signs and periodontitis is still equivocal, the general use of such apparatus is not indicated. The advent of a battery of easily performed chairside tests shows considerable promise for the future, particularly those tests that are becoming commercially available for the assay of host and bacterial markers of site-specific disease in the crevicular fluid. The clinical value and the cost-benefit of these assays need further investigation before they can be recommended for general use. Clinical practice objectives differ from those required for research projects and therefore the required sensitivity, specificity and predictive value of diagnostic tests must be in keeping with the intended purpose to justify the cost involved.