Abstract
Background
The current interest in the assessment of Clinical attachment level (CAL) has stimulated recent introduction of novel periodontal probes. CAL is currently the gold standard for diagnosis and monitoring of periodontal disease. The errors inherent to the use of a periodontal probe are variation in probing force, visual errors in identifying the cemento–enamel junction (CEJ), relative attachment level landmarks, fluctuations in gingival inflammation and misrecording measurements. The present study has been undertaken to compare the accuracy of measuring probing depth (PD) and CAL using Florida probe and Williams probe.
Methods
After random selection of sixty subjects PD and CAL were measured at mandibular first molars region using Williams probe, Florida probe and CEJ probe by two different examiners. The measurements recorded by using three probes were subjected to statistical analysis for comparison of accuracy and reproducibility.
Results
Difference in mean PD with Williams probe and Florida probe were statistically significant with p value of .000. Similarly the CAL measurement achieved by Williams probe and CEJ probe showed significant different results. More consistent results were seen with Florida probe and CEJ probe when the measurements of PD and CAL were done by two different examiners.
Conclusion
Florida probe and CEJ probe have been shown to be more accurate and were found to be more consistent which were reproducible by two independent examiners.
Keywords: Clinical attachment level, Cemento–enamel junction, Florida probe
Introduction
The methods of diagnosis of periodontal disease is evaluated by presence of inflammation, specific bacteria, gingival crevicular fluid flow and periodontal probing demonstrate lack of sensitivity and objectivity to be totally reliable criteria for clinicians.1, 2 Currently, PD, loss of connective tissue attachment and bleeding on probing are generally used to estimate severity of inflammation and response to treatment which needs the use of the periodontal probe.1 One of the more reliable and convenient way of detecting, measuring and assessing the status of periodontal disease activity is through the use of periodontal probes. It has been a goal to find out the most suitable periodontal probe, with the most accurate recording of PD and CAL with maximum comfort for the patients.3
Williams periodontal probe was invented in 1936 by Charles H.M. Williams, which is the prototype or benchmark for all first-generation probes (Fig. 1).4 Common disadvantages of conventional probing are variation in probing force, visual errors in identifying the CEJ, relative attachment level landmarks, fluctuations in gingival inflammation and misrecording of measurements. Earlier pressure sensitive probes have been designed by Amitage in 1977 and Vander Velden in 1978 to standardize the insertion pressure. Subsequently, it was modified with a displacement transducer for electronic pocket-depth reading.5
Fig. 1.
From top to bottom, cemento enamel junction probe, Florida probe, Williams periodontal probe.
The Florida Probe® (Florida Probe Corp, Gainesville, FL) was devised by Gibbs et al in 1988 consisting of a probe hand piece and sleeve, a displacement transducer, a foot switch, and a computer interface/personal computer. The hemispheric probe tip has a diameter of .45 mm and the sleeve has a diameter of .97 mm (Fig. 1, Fig. 2). Constant probing pressure of 15 g is provided by coil springs inside the handpiece. 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.6
Fig. 2.
Florida probe equipment consist of computer/laptop, USB interface, foot controls and probes (Florida probe & cemento enamel junction probe).
The Florida probe also can record missing teeth, recession, pocket depth, bleeding, suppuration, furcation involvement, mobility and plaque assessment.7 Each measurement is recorded with potentially .2-mm accuracy. Comparison to previous data can be made more quickly and accurately (The system shows black arrows for changes between 1 mm and 2 mm and red arrows are used for changes >2 mm). Also, there is a chart showing diseased sites which can be used in patient education. The Florida Probe does have some disadvantages which include, underestimating deep probing depths and a lack of tactile sensitivity. Also, clinicians need to be trained to operate these probes.8
Aim of this study was to assess and compare the accuracy of the Florida probe and Williams periodontal probe in determining the periodontal pocket depth and clinical attachment level. The objectives of study was to determine whether Florida probe is better in determining periodontal pocket depth when compared with Williams periodontal probe and also to determine whether CEJ probe (a component of Florida probe system) is better in determining CAL when compared with Williams periodontal probe. Objective also includes to find out the reliability of two periodontal probes when used by two different examiners.
Materials & methods
A clinical study was carried out amongst the patients attending the Central OPD of Dept of Dental Surgery, AFMC, Pune. A total of 60 subjects were selected according to the undermentioned inclusion and exclusion criteria. An informed consent was taken from all the subjects.
Inclusion criteria
Total of 60 Subjects included were in age group of 35–60 years with more than 14 teeth present in the mouth including mandibular first molars. Thirty cases were with clinical diagnosis of generalized severe chronic periodontitis with probing depth ≥5 mm in more than 1/3rd of total teeth present and thirty with healthy periodontium were subsequently randomly examined.
Exclusion criteria
Patients with history of bleeding disorders, on medication interfering with blood coagulation, with history of severe systemic disease eg. cardiovascular, renal, hepatic or immunologic disorder and patients requiring antibiotic prophylaxis prior to any invasive dental care were excluded in the study.
Procedure
Tooth examined in each patient were mandibular first molars 36 and 46. Probing pocket depth was recorded at six sites in each first mandibular molars i.e. mesiobuccal (L1, L7), mid buccal (L2, L8), distobuccal (L3, L9), mesiolingual (L4, L10), mid lingual (L5, L11) and distolingual (L6, L12) locations of each mandibular first molar 36 and 46 respectively. Each tooth was examined by two observers separately to eliminate inter examiner bias. Pocket depth was recorded by use of Williams periodontal probe and Florida probe in the same sites and same teeth, using custom made acrylic splint on both sides of first molars to make probing location consistent (Fig. 3). Clinical attachment levels was recorded on mandibular first molars at same six sites by two different observers by Williams periodontal probe and CEJ Florida probe using acrylic splint as a guide.
Fig. 3.
Pocket depth being recorded in 36 (i.e. first mandibular left molar) using a custom made acrylic stent.
After collection of data i.e. probing depth and clinical attachment levels, subjects were divided into eight groups as follows:
First examiner
Group A – Pocket depth by Williams periodontal probe.
Group B – Pocket depth by Florida probe.
Group C – CAL by Williams periodontal probe.
Group D – CAL by CEJ Probe (Florida probing system).
Second examiner
Group A1 – Pocket depth by Williams periodontal probe.
Group B1 – Pocket depth by Florida probe.
Group C1 – CAL by Williams periodontal probe.
Group D1 – CAL by CEJ probe.
Comparison of data between Group A & B, Group A1 & B1, Group C& D, Group C1 & D1 was performed by using tabulation and statistical analysis. Statistical analysis was done comparing the results of Probing depth using Williams periodontal probe & Florida probe and CAL by using Williams periodontal probe & CEJ probe (component of Florida probe system) by both examiners.
The tests used for statistical analysis included t-test to find out statistical difference between Williams probe and Florida probe for measuring pocket depth, Williams probe and CEJ probe (component of Florida probe system) for measuring CAL. Paired t test was performed to find out the statistical difference between examiner 1 and 2. Inter examiner reliability was calculated using correlation and alpha values.
Results
Total number of 60 subjects participated in the study. Probing depth and clinical attachment levels were taken as parameters to be examined by examiner 1 & 2. Accordingly the subjects were divided into 4 groups under each examiner.
Comparison of the data by paired t test between Group A & B, Group A1 & B1 suggested that the difference between A & B, A1 & B1 are significant for all readings. Mean is higher in Group A compared to Group B and Group A1 in comparison to Group B1 (Fig. 4) (Table 1).
Fig. 4.
Mean probing depth in mm in Group A, Group B, Group A1 & Group B1 at locations 1 to 12.
Table 1.
Comparison of PD measured by Williams probe and Florida probe by examiner 1 & examiner 2.
| Paired t-test PD–examiner 1 & examiner 2 | |||||||
|---|---|---|---|---|---|---|---|
| Examiner 1 | Mean | Std. deviation | Examiner 2 | Mean | Std. deviation | ||
| Pair 1 | L1 A | 4.93 | 2.612 | Pair 1 | L1 A1 | 4.63 | 1.974 |
| L1 B | 3.80 | 2.140 | L1 B1 | 3.80 | 2.140 | ||
| Pair 2 | L2 A | 3.07 | 2.212 | Pair 2 | L2 A1 | 3.63 | 1.829 |
| L2 B | 2.40 | 1.886 | L2 B1 | 2.40 | 1.886 | ||
| Pair 3 | L3 A | 3.80 | 1.750 | Pair 3 | L3 A1 | 4.33 | 1.647 |
| L3 B | 2.80 | 1.710 | L3 B1 | 2.80 | 1.710 | ||
| Pair 4 | L4 A | 3.07 | 1.461 | Pair 4 | L4 A1 | 3.57 | 1.633 |
| L4 B | 2.60 | 1.329 | L4 B1 | 2.60 | 1.329 | ||
| Pair 5 | L5 A | 2.77 | 1.406 | Pair 5 | L5 A1 | 3.00 | 1.174 |
| L5 B | 1.93 | 1.311 | L5 B1 | 1.93 | 1.311 | ||
| Pair 6 | L6 A | 3.00 | 1.819 | Pair 6 | L6 A1 | 3.17 | 1.367 |
| L6 B | 2.43 | 1.547 | L6 B1 | 2.43 | 1.547 | ||
| Pair 7 | L7 A | 3.17 | 1.599 | Pair 7 | L7 A1 | 3.30 | 1.442 |
| L7 B | 2.47 | 1.224 | L7 B1 | 2.47 | 1.224 | ||
| Pair 8 | L8 A | 2.33 | 1.446 | Pair 8 | L8 A1 | 2.47 | 1.167 |
| L8 B | 1.50 | 1.042 | L8 B1 | 1.50 | 1.042 | ||
| Pair 9 | L9 A | 3.10 | 1.447 | Pair 9 | L9 A1 | 3.20 | 1.324 |
| L9 B | 2.23 | .971 | L9 B1 | 2.23 | .971 | ||
| Pair 10 | L10 A | 2.60 | 1.037 | Pair 10 | L10 A1 | 2.60 | 1.037 |
| L10 B | 2.00 | .643 | L10 B1 | 2.00 | .643 | ||
| Pair 11 | L11 A | 2.43 | .817 | Pair 11 | L11 A1 | 2.43 | .817 |
| L11 B | 1.53 | .629 | L11 B1 | 1.53 | .629 | ||
| Pair 12 | L12 A | 2.60 | 1.037 | Pair 12 | L12 A1 | 2.60 | 1.037 |
| L12 B | 1.80 | .761 | L12 B1 | 1.80 | .761 | ||
| Paired samples test | |||||||
|---|---|---|---|---|---|---|---|
| Examiner 1 | t | ‘p’ value | Examiner 2 | t | ‘p’ value | ||
| Pair 1 | L1 A–L1 B | 7.577 | .000 | Pair 1 | L1 A1–L1 B1 | 5.473 | .000 |
| Pair 2 | L2 A–L2 B | 5.135 | .000 | Pair 2 | L2 A1–L2 B1 | 10.790 | .000 |
| Pair 3 | L3 A–L3 B | 8.515 | .000 | Pair 3 | L3 A1–L3 B1 | 8.332 | .000 |
| Pair 4 | L4 A–L4 B | 4.065 | .000 | Pair 4 | L4 A1–L4 B1 | 5.950 | .000 |
| Pair 5 | L5 A–L5 B | 6.530 | .000 | Pair 5 | L5 A1–L5 B1 | 8.449 | .000 |
| Pair 6 | L6 A–L6 B | 4.011 | .000 | Pair 6 | L6 A1–L6 B1 | 6.886 | .000 |
| Pair 7 | L7 A–L7 B | 5.460 | .000 | Pair 7 | L7 A1–L7 B1 | 6.530 | .000 |
| Pair 8 | L8 A–L8 B | 7.047 | .000 | Pair 8 | L8 A1–L8 B1 | 7.918 | .000 |
| Pair 9 | L9 A–L9 B | 6.500 | .000 | Pair 9 | L9 A1–L9 B1 | 7.370 | .000 |
| Pair 10 | L10 A–L10 B | 4.539 | .000 | Pair 10 | L10 A1–L10 B1 | 4.539 | .000 |
| Pair 11 | L11 A–L11 B | 6.496 | .000 | Pair 11 | L11 A1–L11 B1 | 6.496 | .000 |
| Pair 12 | L12 A–L12 B | 6.595 | .000 | Pair 12 | L12 A1–L12 B1 | 6.595 | .000 |
The difference between A & B is significant B for all 12.PD readings. Mean is higher in A Group compared to B Group B or examiner 1. The difference between A1 & B1 is significant B1for all 12.PD readings. Mean is higher in A1 Group compared to B1 Group B1or examiner 2.
Similarly while comparing the data in between Group C & D, Group C1 & D1, a significant result was observed between Group C & D with mean higher in Group C & C1 (Fig. 5)(Table 2). These results suggested that the readings of probing depth & clinical attachment level were more accurate in Florida probing system & CEJ Probe (component of Florida probe system).
Fig. 5.
Mean clinical attachment levels in mm in Group C, Group D, Group C1 & Group D1 at locations 1 to 12.
Table 2.
Comparison of CAL measured by Williams probe and CEJ probe by examiner 1 & examiner 2.
| Paired t-test CAL–examiner 1 & examiner 2 | |||||||
|---|---|---|---|---|---|---|---|
| Examiner 1 | Mean | Std. deviation | Examiner 2 | Mean | Std. deviation | ||
| Pair 1 | L1 C | 6.03 | 2.798 | Pair 1 | L1 C1 | 5.80 | 2.511 |
| L1 D | 4.60 | 2.328 | L1 D1 | 4.60 | 2.328 | ||
| Pair 2 | L2 C | 4.20 | 2.987 | Pair 2 | L2 C1 | 4.17 | 2.755 |
| L2 D | 3.00 | 2.421 | L2 D1 | 3.00 | 2.421 | ||
| Pair 3 | L3 C | 4.80 | 1.972 | Pair 3 | L3 C1 | 4.63 | 1.903 |
| L3 D | 3.33 | 1.845 | L3 D1 | 3.33 | 1.845 | ||
| Pair 4 | L4 C | 3.90 | 1.583 | Pair 4 | L4 C1 | 4.00 | 1.390 |
| L4 D | 2.47 | 1.479 | L4 D1 | 2.47 | 1.479 | ||
| Pair 5 | L5 C | 3.50 | 1.676 | Pair 5 | L5 C1 | 3.70 | 1.442 |
| L5 D | 2.20 | 1.243 | L5 D1 | 2.20 | 1.243 | ||
| Pair 6 | L6 C | 3.90 | 2.023 | Pair 6 | L6 C1 | 3.23 | 2.029 |
| L6 D | 2.37 | 1.810 | L6 D1 | 2.37 | 1.810 | ||
| Pair 7 | L7 C | 4.13 | 2.193 | Pair 7 | L7 C1 | 4.13 | 2.193 |
| L7 D | 2.80 | 1.827 | L7 D1 | 2.80 | 1.827 | ||
| Pair 8 | L8 C | 3.23 | 1.942 | Pair 8 | L8 C1 | 3.23 | 1.942 |
| L8 D | 2.10 | 1.517 | L8 D1 | 2.10 | 1.517 | ||
| Pair 9 | L9 C | 3.83 | 1.783 | Pair 9 | L9 C1 | 3.83 | 1.783 |
| L9 D | 2.47 | 1.717 | L9 D1 | 2.47 | 1.717 | ||
| Pair 10 | L10 C | 3.47 | 1.676 | Pair 10 | L10 C1 | 3.47 | 1.676 |
| L10 D | 2.17 | 1.262 | L10 D1 | 2.17 | 1.262 | ||
| Pair 11 | L11 C | 3.27 | 1.660 | Pair 11 | L11 C1 | 3.27 | 1.660 |
| L11 D | 1.90 | 1.296 | L11 D1 | 1.90 | 1.296 | ||
| Pair 12 | L12 C | 3.47 | 1.676 | Pair 12 | L12 C1 | 3.47 | 1.676 |
| L12 D | 2.13 | 1.383 | L12 D1 | 2.13 | 1.383 | ||
| Paired Samples test | |||||||
|---|---|---|---|---|---|---|---|
| Examiner 1 | t | ‘p’ value | Examiner 2 | t | ‘p’ value | ||
| Pair 1 | L1 C–L1 D | 10.785 | .000 | Pair 1 | L1 C1–L1 D1 | 7.761 | .000 |
| Pair 2 | L2 C–L2 D | 7.761 | .000 | Pair 2 | L2 C1–L2 D1 | 7.663 | .000 |
| Pair 3 | L3 C–L3 D | 10.351 | .000 | Pair 3 | L3 C1–L3 D1 | 9.497 | .000 |
| Pair 4 | L4 C–L4 D | 10.785 | .000 | Pair 4 | L4 C1–L4 D1 | 11.500 | .000 |
| Pair 5 | L5 C–L5 D | 10.140 | .000 | Pair 5 | L5 C1–L5 D1 | 11.238 | .000 |
| Pair 6 | L6 C–L6 D | 12.324 | .000 | Pair 6 | L6 C1–L6 D1 | 6.500 | .000 |
| Pair 7 | L7 C–L7 D | 10.269 | .000 | Pair 7 | L7 C1–L7 D1 | 10.269 | .000 |
| Pair 8 | L8 C–L8 D | 7.999 | .000 | Pair 8 | L8 C1–L8 D1 | 7.999 | .000 |
| Pair 9 | L9 C–L9 D | 10.420 | .000 | Pair 9 | L9 C1–L9 D1 | 10.420 | .000 |
| Pair 10 | L10 C–L10 D | 8.510 | .000 | Pair 10 | L10 C1–L10 D1 | 8.510 | .000 |
| Pair 11 | L11 C–L11 D | 10.420 | .000 | Pair 11 | L11 C1–L11 D1 | 10.420 | .000 |
| Pair 12 | L12 C–L12 D | 11.050 | .000 | Pair 12 | L12 C1–L12 D1 | 11.050 | .000 |
The difference between C & D is significant for all 12 CAL readings. Mean is higher in C Group compared to D Group for examiner 1. The difference between C1 & D1 is significant D1 for all 12.CAL readings. Mean is higher in C1 Group compared to D1 Group D1 or examiner 2.
Difference between A & B is significant for all twelve PD readings. Mean is higher in Group A compared to Group B for examiner 1. The difference between A1 & B1 is significant for all twelve PD readings. Mean is higher in Group A1 compared to Group B1 for examiner 2. The difference between C & D is significant for all 12 CAL readings. Mean CAL was higher in Group C compared to Group D for examiner 1. The difference between C1 & D1 is significant for all 12 CAL readings. Mean is higher in C1 Group compared to D1 Group for examiner 2. The difference between two examiners is significant for L6 CAL readings. Mean is higher for examiner 1. Difference between two examiners is significant for L2, L3 & L4 PD readings. Mean is higher for examiner 2.
On comparing the CEJ probe and Williams periodontal probe, CEJ probe performed better than Williams periodontal probe. The CEJ Probe has potential to perform more accurately for intra examiner consistency.
Inter examiner comparisons
This study involved recording of all the parameters by two examiners which are tabulated. The data collected from Group A were compared with Group A1, B with B1, C with C1 and D to D1 to exclude the inter examiner bias (Fig. 4, Fig. 5). It was observed that the difference between the two examiners was significant for three readings of “p” value and mean was higher for examiner 2. Comparisons of Group C & C1 showed that the difference between the two examiners was significant for only one CAL readings. Mean was higher for examiner 1. The results after inter examiners comparison confirmed that CEJ probe is most consistent as examiner changed during probing. CEJ probe has shown to be having the most potential consistency than Williams periodontal probe.
Inter examiner reliability Alpha value was calculated. CEJ probe was most consistent as examiner changed during probing. CEJ probe has shown best potential of consistency than Williams periodontal probe (Table 3 a & b).
Table 3.
Inter examiner (examiner 1 and 2) reliability.
| Inter examiner (examiner 1 and 2) reliability – alpha | ||||
|---|---|---|---|---|
| Number |
W |
F |
||
| Correlation | Alpha | Correlation | Alpha | |
| a) For PD – | ||||
| L1 | .8914 | .9233 | 1.0 | 1.0 |
| L2 | .9100 | .9439 | 1.0 | 1.0 |
| L3 | .7418 | .8509 | 1.0 | 1.0 |
| L4 | .8220 | .8992 | 1.0 | 1.0 |
| L5 | .8559 | .9143 | 1.0 | 1.0 |
| L6 | .8182 | .8800 | 1.0 | 1.0 |
| L7 | .8000 | .8863 | 1.0 | 1.0 |
| L8 | .8243 | .8923 | 1.0 | 1.0 |
| L9 | .8896 | .9396 | 1.0 | 1.0 |
| L10 | 1.0 | 1.0 | 1.0 | 1.0 |
| L11 | 1.0 | 1.0 | 1.0 | 1.0 |
| L12 | 1.0 | 1.0 | 1.0 | 1.0 |
| b) For CAL – | ||||
| L1 | .9289 | .9602 | 1.0 | 1.0 |
| L2 | .9719 | .9841 | 1.0 | 1.0 |
| L3 | .9264 | .9614 | 1.0 | 1.0 |
| L4 | .8777 | .9306 | 1.0 | 1.0 |
| L5 | .9201 | .9527 | 1.0 | 1.0 |
| L6 | .9384 | .9682 | 1.0 | 1.0 |
| L7 | 1.0 | 1.0 | 1.0 | 1.0 |
| L8 | 1.0 | 1.0 | 1.0 | 1.0 |
| L9 | 1.0 | 1.0 | 1.0 | 1.0 |
| L10 | 1.0 | 1.0 | 1.0 | 1.0 |
| L11 | 1.0 | 1.0 | 1.0 | 1.0 |
| L12 | 1.0 | 1.0 | 1.0 | 1.0 |
Discussion
The word probe is derived from the Latin word “Probo” which means “to test.” Periodontal probes are used primarily to detect and measure periodontal pockets and clinical attachment loss. In addition, they are also used to locate calculus, measure gingival recession, measure width of attached gingiva, assess size of intraoral lesions, identify tooth and soft-tissue anomalies, locate and measure furcation involvements, determine mucogingival relationships and bleeding tendencies.9 However, periodontal probing has its limitations. Reading errors may result from naturally occurring states, such as interference from the calculus on the tooth or root surface, the presence of an overhanging restoration or the crown's contour. Another factor is operator error such as incorrect angulation of the probe, the amount of pressure applied to the probe, misreading the probe, recording the data imprecisely and miscalculating the attachment loss.10
The use of constant pressure probes has advantages over the use of manual probe. The constant pressure probe provide a constant probing force which may serve to limit some of the errors associated with probe penetration. Constant pressure probes have the capacity for electronic data collection eliminating transcription errors with higher resolution than the manual probes. The resolution is the finest increment the probe can be read to. The resolution of a manual probe is generally 1 mm and is limited by 1 mm markings on the probe where as the resolution of the Florida Probe is .1 mm and is determined by its electronics. The resolution does not necessarily relate to the reproducibility or accuracy of the electronic probe. The reproducibility is how a probe could give the same measurement every time; therefore being highly reproducible.
Out of sixty subjects selected in the study, thirty were with generalized severe chronic periodontitis and 30 subjects with healthy periodontium. Selection of subjects with healthy and diseased periodontium were subsequently examined randomly to avoid the bias arising out of examining only healthy or diseased periodontium.
In our study, the CEJ Probe (component of Florida probe system) appeared to possess the greater potential for consistency in attachment level than Williams probe. Florida probe possess greater consistency in probing depth than Williams probe within Intra and between Inter-Examiners (two examiners). The difference in intra examiner consistency between CEJ probe, Florida probe and Williams probe was small. Data demonstrated that the CEJ and Florida probe were more consistent statistically. The result from present study are consistent with those presented by Preshaw et al (1999)11 and Karpinia et al (2004).12
Various factors such as probe-tip size, angle of insertion of the probe, probing pressure, precision of probe calibration and degree of inflammation in the underlying periodontal tissues affect the sensitivity and reproducibility of measurements. Because the probe passes through the junctional epithelium into the underlying connective tissue in an inflamed gingival sulcus, readings of clinical pocket depth obtained with the periodontal probes do not normally coincide with the measurements up to the base of the pocket.13
Sequential probing of periodontal attachment remains the most commonly utilized method to diagnose progressive destruction of the periodontium. The probing itself is the heart of the problem and many improvements have been sought.10, 14, 15 The pressure applied at the probe tip is a function of the probing force. Therefore as the probe force increases the CAL measurements also tend to increase. However the actual penetration of the probe tip into the epithelial attachment or underlying connective tissue is influenced to a great extent by the diameter and shape of the probe tip. The probing pressure at the probe tip is then proportional to probe force and inversely proportional to probe tip diameter. Ultimately the penetration of the periodontal probe at the base of the pocket is due to a combination of probe tip design, probing force and the inflammatory condition of the connective tissue at the base of the pocket.16, 17 In our study healthy and diseased subjects have been included to rule out bias due to change in the condition of the connective tissue at the base of the pocket. In addition to this, study has shown that constant probe system (Florida probe) has given superior results to manual Williams periodontal probe in measuring the pocket depth and CAL accurately.
This probing method combines the advantages of constant probing force with precise electronic measurement and computer storage of data, thus eliminating the potential errors associated with visual reading and the need for an assistant to record the measurements. These automated probes also introduce problems. The probing elements lack tactile sensitivity mainly because of their independent movement which forces the operator to predetermine an insertion point and angle. In the current study a custom made acrylic stent has been used to eliminate the errors of probing because of the change in direction. The manual Williams periodontal probing has shown to produce patient discomfort when compared to constant pressure Florida probing system throughout this study. This may be attributed to the uncontrolled force applied in the manual probe while probing. One common problem was encountered as the underestimation of deep probing depths by the automated probe, which is similar to the study by Perry D A et al 1994.18
The comparative evaluation between the conventional Williams periodontal probe and Florida probing system in the present study has confirmed that efficacy of Florida probing system for measurement of probing depth and clinical attachment levels is more consistent. It is recommended for multicentre study employing larger numbers of subjects and examiners for further evaluation.
Conflicts of interest
All authors have none to declare.
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