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 Table of Contents  
REVIEW ARTICLE
Year : 2017  |  Volume : 8  |  Issue : 2  |  Page : 78-81

Chairside diagnostics in periodontics


Department of Periodontics, SRM Kattankulathur Dental College and Hospital, Kanchipuram, Tamil Nadu, India

Date of Web Publication8-Jun-2017

Correspondence Address:
D Mithra
SRM Kattankulathur Dental College and Hospital, Potheri, Kanchipuram, Tamil Nadu
India
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DOI: 10.4103/srmjrds.srmjrds_4_17

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  Abstract 


In the field of periodontology, the success of any treatment is based on the accuracy of the initial diagnosis. Traditional clinical measurements used for periodontal diagnosis are often of limited usefulness as they are indicators of previous periodontal disease rather than the present disease activity. Many of the biochemical, microbiological, gingival crevicular fluid, and salivary diagnostic tests are commercially available chairside tests Offers, that make the monitoring of periodontal disease activity more efficient. Chairside diagnostic kits offer rapid, reproducible mode of diagnosis and the results can be used for patient motivation as well. This review highlights various chairside diagnostic kits that facilitate diagnosis and improve prognosis.

Keywords: Chairside tests, diagnosis, periodontal disease


How to cite this article:
Ravishankar P L, Mithra D, Chakraborty P, Kumar A. Chairside diagnostics in periodontics. SRM J Res Dent Sci 2017;8:78-81

How to cite this URL:
Ravishankar P L, Mithra D, Chakraborty P, Kumar A. Chairside diagnostics in periodontics. SRM J Res Dent Sci [serial online] 2017 [cited 2021 Sep 27];8:78-81. Available from: https://www.srmjrds.in/text.asp?2017/8/2/78/207649




  Introduction Top


In the past few decades due to the evidences that periodontitis does not affect all people and that it need not progress in a continuous manner and can be a specific problem, the understanding of the nature of the disease has been altered. Despite our increased understanding of the etiology and pathogenesis, the diagnosis and classification of the disease are still based almost entirely on traditional clinical assessments. To arrive at a periodontal diagnosis, the dentist must rely upon factors such as presence or absence of clinical signs of inflammation, probing depth, extent and pattern of loss of clinical attachment and bone, patient's medical and dental histories, presence or absence of miscellaneous signs and symptoms including pain, ulceration, and amount of observable plaque and calculus.[1]

As the limitation of these traditional procedures become clear, several new techniques have been proposed as diagnostic tests for periodontal disease which were mainly on the following categories.

  1. Plaque bacteria
  2. Assessment of metabolic changes associated with identification of periodontopathic bacteria
  3. Assessment of susceptibility of host
  4. Detection of tissue damage, necrosis, or anatomical changes in the periodontium.[2]


An array of supplemental diagnostic tests has been developed that can be used to perform two basic tasks. The first is to separate diseased from nondiseased patients and the second is to detect sites or patients undergoing the progression of periodontitis. It is also of great importance since the clinician separates healthy from periodontitis-affected patients based on customary clinical criteria.[3]

The clinical value of these tests are potentially useful in identifying the presence of therapeutic targets monitoring the response to therapy identifying sites at high risk for progression and assisting the clinician in determining a patient-specific recall interval for periodontal maintenance therapy.

Several supplemental diagnostic tests are currently available and some are under development. Most of them are designed to provide information presumably associated with progressing periodontal lesions.

The various supplementary diagnostic kits are:


  Evalusite Top


It is a novel membrane immunoassay commercially available for the chairside detection of three periodontal pathogens. It involves linkage between the antigen and a membrane bound antibody to form an immunocomplex that is later revealed through a colorimetric reaction. This assay is a sandwich configuration. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia are detected by the procedure.[4] The procedure can be performed in 10 min.

The limit of detection for the 3 species ranges upward from approximately 5 × 104 to 5 × 105 to bacterial cells.[5]


  Omnigene Top


These are DNA probe systems for a number of subgingival bacteria. Probes are available for the detection of A. actinomycetemcomitans, P. gingivalis, P. intermedia, Eikenella corrodens, Fusobacterium nucleatum, Campylobacter rectus, Treponema denticola, and Treponema pectinovorum.[6]


  Micro Probe Corporation Top


This company has developed an in-office nucleic acid probe assay for the semiquantitative detection of periodontal pathogens. The bacterial cells in patient plaque samples are lysed by heating in the presence of detergent. The extracted DNA is then placed into the first well of a multiwell cassette and then placed into a machine with a programmable robotic arm which gives digital display of current bacterial load.[7]


  Perioscan Top


This is a chairside test kit system which is developed to detect bacterial trypsin-like proteases in dental plaque. Tannerella forsythia, P. gingivalis, T. denticola, and Capnocytophaga species all have in common a trypsin-like enzyme. The activity of this enzyme can be measured with the hydrolysis of the colorless substrate N-benzoyl-DL-arginine-2-napthylamide (BANA). Besides, since it only detects very limited number of pathogens, its negative results does not rule out the presence of other important periodontal pathogens.[8]


  Benzoyl-Dl-Arginine-2-Napthylamide-Enzymatic Test Kit Top


BANA-enzymatic test™ kit (Ora Tec Corporation, Manassas, USA) is a rapid and reliable chairside diagnostic test, which can be performed in about 15 min, that can give information about the presence of three of the putative pathogens in subgingival plaque samples, that is, P. gingivalis, T. denticola, and T. forsythia that share unique ability of hydrolyzing the trypsin substrate, BANA.[9],[10]

This allows for the use of BANA-enzymatic test kit as a potential chairside test to detect the presence of severe periodontitis. The presence of negative result in the presence of disease means:

  1. Improper sample collection site and/or technique
  2. Disease is associated with the presence of non-BANA organisms.



  Perioguard Top


This commercial test kit is based on detection of aspartate aminotransferase (AST) which is released from dead cells of periodontium to the gingival crevicular fluid (GCF). The test kit consists of a tray with two test wells for each tooth and appropriate reagents for conducting the test.[11]


  Periocheck Top


It is the rapid chairside test for neutral proteases in GCF such as elastases, proteinases, and collagenases.[12] The levels of these enzymes in GCF have been noted to increase with the development of gingivitis as well as sites of established periodontitis. However, limited longitudinal studies evaluated the utility of these markers as indicator of periodontal disease.


  Pocket Watch Top


The pocket watch was developed as a simple method of analyzing AST at the chairside.[13]

AST activity determined by pocket watch provides not only an index of cell death but also the extent of the destructive pockets.


  Prognostik Top


This test is an assay for elevated levels of elastase in crevicular fluid. The presence of elevated levels of elastase in the crevicular fluid may thus be indicative of active disease sites.[12] Although a relationship between elastase levels in crevicular fluid and periodontal disease activity has been reported, the position is still far from clear.


  Perio 2000 Top


Various pathogenic bacteria (T. denticola, P. gingivalis, P. intermedia, and T. forsythia) are able to produce sulfates, thereby producing significant levels of these volatile sulfur compounds can directly degrade periodontal structures aggravating periodontitis. Hence, Diamond Probe/Perio 2000 system is designed to display the sulfide level digitally at each site.[14]


  Periodontal Susceptibility Test Genetic Susceptibility Test Top


Periodontal susceptibility test is the first and only genetic test that analyzes two interleukin-1 (IL-1) genes for variations that identify an individual's susceptibility to overexpression of inflammation and risk for periodontal disease. The initiation and development of the disease may not be due to IL-1 genetic susceptibility, but rather it may lead to earlier or more severe disease. This test does not provide information for just a single disease or is it useful to ascertain a diagnosis of a specific disease. The IL-1 genetic test can be used to differentiate certain IL-1 genotypes associated with different levels of inflammatory responses to identify individuals at risk for severe periodontal disease even before age 60.[15]

Monitoring infections which are episodic, site-specific, localized or generalized, initiated by an array of microorganisms and assessed with measurement devices that have inherent shortcoming presents a difficult task. The lack of precise clinical criteria for assessment of periodontal disease has led to a search for alternative means of determining active disease sites, predicting future sites of breakdown, and evaluating response to therapy.

Are they good indicators of risk of periodontal disease at individual level?

Traditional diagnostic tests are subjective, retrospective, and they are not enough to detect small degrees of periodontal damage. They neither can identify susceptible individuals nor can differentiate between active and nonactive disease sites. GCF-based test provides some hope in this regard, but each of these components acting as diagnostic markers are not clearly known.

Saliva kit for identification of Porphyromonas gingivalis colonies

Detection of P. gingivalis using the saliva kit and P. gingivalis levels in saliva and plaque as determined by real-time polymerase chain reaction (PCR) Can be done. A sensitivity of 92% and a specificity of 96% were found when compared to real-time PCR at a 105P. gingivalis cell threshold.

The P. gingivalis saliva kit was shown to be rapid and has a comparable detection capacity to real-time PCR.[16]

Matrix metalloproteinases and myeloperoxidase

GCF samples of various sites were tested for the presence of azurocidin, chemokine ligand 5, myeloperoxidase (MPO), tissue inhibitors of metalloproteinase-1 matrix metalloproteinase 13 (MMP-13), and MMP-14 by ELISA or activity assays. MMP-8, MPO, azurocidin, and total MMP-13 and MMP-14 were higher in periodontitis compared to gingivitis and healthy sites. MMP-8 determined by immunofluorometric assay correlated more strongly with periodontal status and showed higher diagnostic accuracy than ELISA.[17]

Commercially available diagnostic test kits

  • Periocheck: Neutral proteinases approved by Food and Drug Administration (FDA)
  • Perioguard: AST
  • Prognostik: Elastase not approved by FDA and ADA American Dental Association
  • Biolise: Elastase
  • Pocket watch: AST
  • TOPAS: Bacterial toxins and proteases
  • MMP dipstick method: MMPs
  • Under development, for B: Glucornidase and proteinases.[1],[6],[11],[13],[12],[5]



  Conclusion Top


Many of the chairside diagnostic tests have been marketed before verifiable evidence of their predictive ability to detect periodontal disease. The newer commercially available chairside tests offer exciting prospects in general practice. In certain situations, these supplemental tests may be particularly valuable in establishing the endpoint of therapy before placing patients on a periodontal maintenance program. Further research and development are warranted. The novel tests need to be validated according to gold standards such as alveolar bone loss in large numbers also being of economic value to both patient and practitioner.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Armitage GC; Research, Science and Therapy Committee of the American Academy of Periodontology. Diagnosis of periodontal diseases. J Periodontol 2003;74:1237-47.  Back to cited text no. 1
    
2.
Highfield J. Diagnosis and classification of periodontal disease. Aust Dent J 2009;54 Suppl 1:S11-26.  Back to cited text no. 2
    
3.
Armitage GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol 2000 2004;34:9-21.  Back to cited text no. 3
    
4.
Boyer BP, Ryerson CC, Reynolds HS, Zambon JJ, Genco RJ, Snyder B. Colonization by Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in adult periodontitis patients as detected by the antibody-based Evalusite Test. J Clin Periodontol 1996;23:477-84.  Back to cited text no. 4
    
5.
Pajnigara NG, Kolte AP, Kolte RA, Pajnigara NG. Chair side diagnostic kits in periodontics. International Dental Journal of Students Research 2016;4:25-31.  Back to cited text no. 5
    
6.
Van Arsdell SW, DiFronzo F, Backman KC, Mahler PH. Selling biotechnology in the dental medicine marketplace: The OmniGene Diagnostics DNA probe tests for periodontal pathogens. Technol Health Care 1996;4:339-46.  Back to cited text no. 6
    
7.
Zambon JJ, Haraszthy VI. Laboratory diagnosis of periodontal infections. Periodontology 2000 1995;7:69-82.  Back to cited text no. 7
    
8.
Africa CW, Bayingana C, Yasin-Harnekar S. The use of Perioscan as a potential screening test for mothers at risk for delivery of pre-term and low birth-weight infants. J Int Acad Periodontol 2009;11:193-9.  Back to cited text no. 8
    
9.
Ishihara K, Naito Y, Kato T, Takazoe I, Okuda K, Eguchi T, et al. A sensitive enzymatic method (SK-013) for detection and quantification of specific periodontopathogens. J Periodontal Res 1992;27:81-5.  Back to cited text no. 9
    
10.
Dhalla N, Patil S, Chaubey KK, Narula IS. The detection of BANA micro-organisms in adult periodontitis before and after scaling and root planing by BANA-Enzymatic™ test kit: An in vivo study. J Indian Soc Periodontol 2015;19:401-5.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Persson GR, Alves ME, Chambers DA, Clark WB, Cohen R, Crawford JM, et al. A multicenter clinical trial of PerioGard in distinguishing between diseased and healthy periodontal sites. (I). Study design, methodology and therapeutic outcome. J Clin Periodontol 1995;22:794-803.  Back to cited text no. 11
    
12.
Armitage GC, Jeffcoat MK, Chadwick DE, Taggart EJ Jr., Numabe Y, Landis JR, et al. Longitudinal evaluation of elastase as a marker for the progression of periodontitis. J Periodontol 1994;65:120-8.  Back to cited text no. 12
    
13.
Shimada K, Mizuno T, Ohshio K, Kamaga M, Murai S, Ito K. Analysis of aspartate aminotransferase in gingival crevicular fluid assessed by using PocketWatch: A longitudinal study with initial therapy. J Clin Periodontol 2000;27:819-23.  Back to cited text no. 13
    
14.
Mani A, Anarthe R, Marawar PP, Mustilwar RG, Bhosale A. Diagnostic kits: An aid to periodontal diagnosis. J Dent Res Rev 2016;3:107-13.  Back to cited text no. 14
  [Full text]  
15.
Greenstein G, Hart TC. Clinical utility of a genetic susceptibility test for severe chronic periodontitis: A critical evaluation. J Am Dent Assoc 2002;133:452-9.  Back to cited text no. 15
    
16.
O'Brien-Simpson NM, Burgess K, Brammar GC, Darby IB, Reynolds EC. Development and evaluation of a saliva-based chair-side diagnostic for the detection of Porphyromonas gingivalis. J Oral Microbiol 2015;7:29129.  Back to cited text no. 16
    
17.
Leppilahti JM, Hernández-Ríos PA, Gamonal JA, Tervahartiala T, Brignardello-Petersen R, Mantyla P, et al. Matrix metalloproteinases and myeloperoxidase in gingival crevicular fluid provide site-specific diagnostic value for chronic periodontitis. J Clin Periodontol 2014;41:348-56.  Back to cited text no. 17
    




 

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  In this article
Abstract
Introduction
Evalusite
Omnigene
Micro Probe Corp...
Perioscan
Benzoyl-Dl-Argin...
Perioguard
Periocheck
Pocket Watch
Prognostik
Perio 2000
Periodontal Susc...
Conclusion
References

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