25

REVIEW ARTICLE

Chair side diagnostic kits in Periodontics

Dr. Natasha G Pajnigara 1, Dr. Abhay P Kolte 2,
Dr. Rajashri A Kolte 3, Dr. Nilufer G Pajnigara4 Introduction
1 “A correct diagnosis is three fourths the remedy” –
Post graduate student
2 M. K. Gandhi. Diagnosis is the identification of a
Professor and Head
3 condition, disease, disorder, or problem by
Professor
systematic analysis of the background or history,
Department of Periodontics and Implantology
4 examination of the signs or symptoms, evaluation
Post graduate student
of the research or test results, and investigation of
Department of Oral Medicine and Radiology
the assumed or probable causes. Effective
VSPM Dental College and Research Centre,
prognosis is not possible without effective
Nagpur, India
diagnosis.
Periodontitis is a set of inflammatory diseases
Corresponding Author affecting the periodontium, i.e., the tissues that
Dr. Natasha Gev Pajnigara surround and support the teeth. Periodontitis
VSPM Dental College and Research Centre, involves progressive loss of the alveolar bone
Digdoh Hills, Hingna Road, Nagpur, India around the teeth, and if left untreated, can lead to
440019. the loosening and subsequent loss of teeth.
E-mail: [email protected] Periodontitis is caused by microorganisms that
Phone: +91- 8888819816 adhere to and grow on the tooth's surfaces, along
with an over-aggressive immune response against
these microorganisms. A diagnosis of periodontitis
Access this Article Online is established by inspecting the soft gum tissues
around the teeth with a probe (i.e., a clinical
www.idjsr.com
examination) and by evaluating the patient's X-ray
films (i.e. a radiographic examination), to
Use the QR Code scanner to access this determine the amount of bone loss around the
article online in our database
teeth.1
"Periodontal Diagnosis" is an important tag that a
Article Code: IDJSR 0140 clinician ties on the periodontal disease condition
Quick Response Code of the patient, capturing all his past experience with
the condition in question. The entire constellation
of signs and symptoms, along with a detailed
history is elicited, documented and interpreted to
Abstract reach at a diagnosis. Most often an accurate
A good clinical diagnosis is the need for the hour. diagnosis is, the very first concrete step towards the
Proper diagnosis is essential for better treatment planning and execution of an appropriate
planning of the disease. Traditional clinical individualized treatment plan, contributing
measurements used for periodontal diagnosis are significantly towards the success of the therapy 2.
often of limited usefulness as they are indicators of It is relatively easy to detect significant anatomical
previous periodontal disease rather than present damage, caused by advanced stage of periodontal
disease activity. Hence, there is a need for disease with conventional diagnostic aids. On the
developing novel diagnostic kits that can detect other hand early or incipient disease detection
active disease, predict future disease emergency or serves as a challenge even for the most experienced
progression and evaluate response to periodontal clinician. Emphasis on early detection serves as an
therapy, therapy facilitating management of impulse for managing the disease with minimally
periodontal patient. In this modern era there has invasive and economic therapeutic modalities.
been tremendous research in the field of diagnostic Hence, there is a need for developing novel
tools that can be used by periodontists in their daily diagnostic kits that can detect active disease,
practice. Different chair side diagnostic kits are predict future disease emergency or progression
discussed in this review which would be helpful for and evaluate response to periodontal therapy,
proper diagnosis, evaluating a disease prognosis therapy facilitating management of periodontal
and proper treatment planning. patient. The available chair side diagnostic kits are
Keywords: Periodontal disease, diagnostic, chair designed to measure microbiological, immunologic
side tests. and genetic constituent in oral diagnostic fluids

INTERNATIONAL DENTAL JOURNAL OF STUDENT’S RESEARCH| April 2016 | Volume 4| Issue 1

 26

namely; saliva and gingival crevicular fluid (GCF), immunosorbent assays, trypsin-like protease
indicative of health or disease. assays, DNA probes 9 and the PCR 10.
These tests are technique sensitive making Among these tests, chairside periodontal kits
harvesting of a sample and reproducing the results provide immediate reports of the microflora
a tedious task. Also, the specificity and sensitivity associated with the disease compared to
of these diagnostics is fundamentally limited by cumbersome and time-consuming traditional
their inability to simultaneously measure the local laboratory procedures. Chairside periodontal test
concentration of multiple biomarkers. Hence rapid kits can be categorized as
chair side diagnostic tests should be developed that 1. Microbiological test kits
provide maximum information with minimal 2. Biochemical test kits
technicalities. 3. Genetic kits.
More than 200 species of microorganisms colonize
the oral cavity, but only a few of these are thought 1. Microbiological test kits
to be pathogens. 3 Among the subgingival bacterial Enumeration and identification of the microflora of
species identified so far, Porphyromonas gingivalis the periodontal pocket have been an important part
(Pg), Prevotella intermedia (Pi) and of research efforts for many decades. It is thought
Aggregatibacter actinomycetemcomitans (Aa) have that as many as 300 distinct bacterial species can
been associated with progressive periodontitis4. Aa inhibit the periodontal pocket. Many of these have
is infrequently found in periodontally healthy not been identified.
individuals 5, whereas Pi has been found in either The microbiological tests have the potential to
healthy subjects or patients with gingivitis 6. support the diagnosis of various forms of
Elevated levels of these putative pathogens may be periodontal disease, to serve as indicators of
useful indicators of both active periodontitis and disease initiation and progression and to determine
increased risk of gingival attachment loss. which periodontal sites are at higher risk for active
The goal of periodontal diagnostic procedures is to destruction. The bacteriological tests (Microscopy,
provide useful information to the clinician Culture, Omnigene, Affirm DP and Evalusite) are
regarding the present periodontal disease type, mainly aimed at spirochetes, Aa, Pg and Pi.
location and severity. Traditional clinical Microbial tests can also be used to monitor
measurements (probing pocket depth, bleeding on periodontal therapy directed towards the
probing, clinical attachment loss, plaque index, suppression or eradication of periodontopathogenic
radiographs) used for periodontal diagnosis are organisms.
often of limited usefulness in that they are
indicators of previous periodontal disease rather
Omnigene
than present disease activity.
These are DNA probe systems for a number of
The ideal diagnostic test should be 7, 8:
known periodontopathogen subgingival bacteria.
1. Highly specific, sensitive, reproducible and
OmniGene Diagnostics, Inc. has applied the
quantitative.
principles of genetic engineering to develop
2. Simple to perform, rapid, one-stage or a two-
species-specific DNA probe tests for eight
stage procedure.
periodontal pathogens (Porphyromonas gingivalis,
3. Non-invasive.
Prevotella intermedia, Actinobacillus
4. Versatile in terms of sample handling, storage
actinomycetem-comitans, Fusobacterium
and transport.
nucleatum, Eikenella corrodens, Campylobacter
5. Amenable to chairside use.
rectus, Bacteroides forsythus, and Treponema
6. Economical.
denticola). The test requires minimal effort on the
part of the clinician: subgingival plaque samples
Objectives of chair side tests
are collected from the patient and sent through the
1. They are minimally invasive, thus having an
mail for analysis by OmniGene Diagnostics' fully
edge over conventional diagnostic aids.
licensed clinical reference laboratory. Results are
2. Relatively less tedious to the patient as the
transmitted to the practitioner by phone, fax, or
appointment time is reduced.
mail. The use of diagnostic tests for periodontal
3. Less cumbersome or technique sensitive, making
pathogens is a relatively new concept in dentistry
them user friendly.
and acceptance of the OmniGene Diagnostics tests
4. Help in early diagnosis and treatment planning.
by the dental marketplace has been slower than
5. Can be used as an encouragement tool to
anticipated. OmniGene Diagnostics' challenge for
motivate the patient.
the future is to persuade the dental community that
monitoring periodontal pathogen levels, as well as
Several methods have been employed to detect
other clinical indicators of disease, is essential to
putative periodontopathogens in clinical samples.
providing optimal care to the periodontitis patient.11
These include cultural methods, microscopy,
immunofluorescent assays, enzyme-linked

INTERNATIONAL DENTAL JOURNAL OF STUDENT’S RESEARCH| April 2016 | Volume 4| Issue 1

 27

Merits
1. Reports are provided within short periods of PerioScan®
time, few hours to few days. Perioscan is a diagnostic test kit that utilizes the
2. It helps in identification of number of known BANA (N-benzoyl-DLarginine- 2 naphthylamide)-
periodontal pathogen12 hydrolysis reaction, developed to detect bacterial
trypsin-like proteases in the dental plaque. The
microbial-enzymatic BANA test is one of the
modern alternatives to bacterial cultures. It detects
the presence of three periodontal pathogens in the
subgingival plaque (T. denticola, P. gingivalis, and
B. forsythus).
The BANA test (Figure 3) was developed by Dr.
Walter Löesche and co-workers at Michigan
University, being the result of more than 15 years
of research. Of the 60 bacterial species studied in
the subgingival microbiota, only the anaerobic
bacteria Porphyromonas gingivalis, Bacteroides
forsythus and Treponema denticola possess a
Figure 1- Omnigene trypsin-like enzyme, which hydrolyzes the
synthetic peptide benzoyl- DL-arginine-
Evalusite (Kodak) naphthylamide or BANA. The test can detect the
It is a novel membrane immunoassay commercially presence of these three anaerobic species, without
available in Europe and Canada for the Chairside being able to differentiate them15.
detection of 3 periodontal pathogens. It involves The BANA test is very sensitive, detecting small
linkage between the antigen and a membrane quantities of pathogens. No meaningful differences
bound antibody to form an immunocomplex that is could be found between DNA probes,
revealed through a calorimetric reaction. The immunological reagents and the BANA test, when
patient plaque sample is prepared by the addition of seeking to detect these species in plaque samples
a detergent, mixed and then squeezed through a removed from periodontal disease patients.16,17,18
filter into a reagent well. Membrane bound The test can be used for assessment of oral
antibody in the well specific to halitosis, to detect the presence of two BANA
A.actinomycetemcomitans, P.gingivalis and positive species on the tongue surface:
P.intermedia reacts with plaque sample. Antigen Stomatococcus mucinlagenous and Rothia
and antibody complexes formed on the membrane dentocariosa.
are detected by the addition of an enzyme-labelled
second antibody together with a colored enzyme
substrate. Separate dots indicate the presence of 3
different species.13

Merits
It employes a normal membrane base enzyme
immunoesaay for the detection of three putative
periodonto pathogens. (Aa, Pg, Pi).
Demerits
1. It is multistage test.
2. It has a subjective calorimetric end point.
3. There is no permanent record of the result.
4. Gives the assumption that the three organisms Figure 3 - BANA Test
are causing the disease. 14
Principle of BANA test
Peptidases of these three bacterial species (T.
denticola, P. gingivalis, and B. forsythus) can
hydrolyze the peptide analog N-benzoyl-DL-
arginine-2 naphthylamide (BANA). One of the
hydrolytic products of this reaction is B-
naphthylamide, which reacts with a reagent, which
is imbedded in the upper strip of the test, producing
a permanent blue color. Blood and saliva do not
19
interfere with the test .
Figure 2 - Evalusite

INTERNATIONAL DENTAL JOURNAL OF STUDENT’S RESEARCH| April 2016 | Volume 4| Issue 1

 28

The BANA test is a plastic strip to which two Perio 2000

separate reagent matrices are attached. The lower The Diamond Probe/Perio 2000 System is a
white reagent matrix is impregnated with N- periodontal probe that combines advanced ion
benzoyl- DL-arginine-B-napthylamide (BANA). selective electrode technology with the standard
Subgingival plaque samples are applied to this "Michigan O" style probe
lower matrix. The upper buff reagent matrix The Diamond Probe/Perio 2000 System is a
contains a chromogenic diazo reagent, which reacts periodontal probe that combines advanced ion
with one of the hydrolytic products of the enzyme selective electrode technology with the standard
reaction, forming a blue color. The blue color "Michigan O" style probe. It is intended to measure
appears in the upper buff matrix and is permanent. probing depths, to evaluate the presence or absence
The intensity of the color determines whether it is a of bleeding or probing, as well as to detect the
positive or weak reaction. presence of sulfides in periodontal pockets. The
sulfide sensor component in the system is used as
Directions for use an adjunct to traditional diagnostic techniques in
Anaerobic microorganisms associated with the evaluation of periodontal diseases in adult
periodontal disease are found in the subgingival patients.
plaque. To obtain specimens for testing, sites The system consists of:
should be cleared of supragingival plaque. A 1. Single use, disposable sensor tips that combine
Gracey curette may be used to obtain subgingival an updated standard Michigan "O" style dental
plaque specimens, which are placed on the lower probe with a sulfide sensor for use during one-time
matrix. Four teeth should be sampled in each examinations
subject. Before taking another specimen, wipe the 2. An electronic control unit that provides real-time
curette on a clean piece of cotton or other suitable visual feedback of bacterial activity to the
wipe to prevent carry-over of plaque. Then the practitioner and patient
upper matrix is moistened with saline solution and 3. Probe handle, hand-piece cable, foot switch, and
the test is folded so as the two matrices are coming external power supply
in contact. It is incubated for 5 minutes at 55 4. Wash solution
Celsius degrees temperature. If BANA positive 5. Accessory stand for convenient wash cup
species are present when the test is opened, a placement and temporary probe storage
permanent blue coloration on the upper matrix is 6. System check
found. The higher the concentration of bacterial It can be used:
species, the darker blue coloration is present on the 1. During initial patient screening as an adjunctive
test. According to the result, the test can be measurement of a patient's oral health status
positive, weak positive, or negative. 2. During and after routine supportive periodontal
therapy
Merits 3. At maintenance intervals
Used to identify volatile sulphur compounds in 4. As a tool to provide patient education and
halitosis patients motivation.23
Demerits
1. In this test, there is always a lack of quantitative
data.
2. The specific bacteria that are responsible for
enzyme production can’t be determined.
3. They cannot identify the presence of other
pathogens that do not produce trypsin like enzyme.
4. The results are qualitative and rely upon the
Figure 4 - Perio 2000
operator’s assessment at the calorimetric end
point.20,21,22
Prognos-Stik
This test kit was released in the year 1993. It
detects elevated levels of MMPs in the gingival
2. Biochemical test kits crevicular fluid such as the elastases. The GCF is
Biochemical test kits used in periodontics analyze collected onto the filter paper strip impregnated
the gingival crevicular fluid (GCF). Since this fluid with a known amount of buffered elastase substrate
is derived from periodontal tissues, evaluating its labeled with a fluorescent indicator. Elastase on the
constituents such as host-derived enzymes, test strip cleaves the substrate during the reaction
inflammation mediators and extracellular matrix time of 4-6 minutes and releases the indicator,
components may provide early signs of alterations. visible under fluorescent light. Elastase is released
from the lysosomes of polymorphonuclear
leucocytes which accumulate at sites of gingival
inflammation. The presence of elevated levels of

INTERNATIONAL DENTAL JOURNAL OF STUDENT’S RESEARCH| April 2016 | Volume 4| Issue 1

 29

elastase in GCF may thus be indicative of active catalyzed to oxaloacetate and glutamate. The
disease sites 24. Although a relationship between addition of a dye such as fast red results in a color
elastase levels in GCF and periodontal disease product, the intensity of which is proportional to
activity has been reported, the position is still far the AST activity in the GCF sample. In practice,
from clear. Further clinical trials are needed before the PerioGard assay suffers from poor
the value of this test kit in clinical practice can be differentiation between colors and is a relatively
ascertained. complex procedure involving multiple steps.

Periocheck PerioWatch
Periocheck (Advanced Clinical Technologies Inc., The PerioWatch was developed as a simple method
Westwood, MA 02090, USA) is a rapid chairside of analyzing Asparate amino Transferase (AST) at
test to detect the presence of neutral proteases. the chairside. The principle of this test is that, in the
Periocheck has FDA (Food and Drug presence of pyridoxal phosphate, AST catalyzes the
Administration) approval in the United States. The transfer of an amino group from cysteinesulfinic
presence of these enzymes has been implicated in acid, by a aketoglutaric acid to yield β-sulfinyl
collagen breakdown which is an important feature pyruvate and glutamate. β-sulfinyl pyruvate rapidly
of periodontal disease. Crevicular fluid is collected decomposes and releases inorganic sulfite which
on filter paper strips and these are placed on a react with malachite green to convert from a green
collagen dye labelled gel matrix. Soluble dye- dye to colourless form. The rate of conversion of
labelled fragments of collagen are formed from the malachite green is directly proportional to the AST
reaction of neutral proteases with the gel and these concentration.
diffuse onto the sample strip turning the papers
colour to blue. The quantity and intensity of the
colour reaction is compared to a standard colour
3. Genetic test kits
Various gene polymorphisms are considered to be
chart and is related to the level of neutral protease
risk factors for the initiation or progression of
activity originally present in the crevicular fluid
periodontal disease. In 1997, Kornman et al. 29
sample.25 The test is only qualitative and not
found an association between the polymorphism in
specific for PMNL collagenase, which is thought to
the genes encoding for interleukin-1α and
be the dominant collagenase at active sites 26.
interleukin-1β and increased severity of
Indeed, a high proportion of the enzyme is likely to
periodontitis. Identification of the genetic
be bacterial in origin. Furthermore, interproximal
polymorphism is difficult but now some chairside
sites cannot be sampled, due to the risk of saliva
kits are available for its detection.
contamination, and this is clearly a major drawback
with this method. It is the most rapid chairside test
for neutral proteases in GCF like elastases, PST Genetic Susceptibility Test
proteinases and collagenases. The levels of these Ever wonder why some people with loads of plaque
enzymes in GCF have been noted to increase with don't get attachment loss and others with good
the development of gingivitis as well as sites of hygiene are losing teeth? Common sense and more
established periodontitis. recently science indicate that there is an inherited
component of periodontal disease that is very
important in determining disease behaviour.
PerioGard
Clinicians have recognized for years that some
PerioGard is based on the detection of an enzyme
individuals get lots of plaque and calculus, but
called aspartate aminotransferase (AST). AST is a
experience little loss of periodontal support. Other
soluble intracellular cytoplasmic enzyme that is
patients seem to have really clean mouths, but
released from within the cell upon its death. Since
experience extensive bone loss. Their disease is not
cell death is an important part of periodontal
so much related to the presence of bacteria but to
pathogenesis, AST levels in GCF have great
some other factor. Within the past two years, a
potential as markers of early periodontal tissue
genetic marker has been identified that can be
destruction. Elevated total AST levels in a 30-
correlated with the degree of tissue destruction that
second sample have been positively associated with
occurs in some periodontal patients with advanced
disease-active sites in contrast to inactive sites 27,28.
disease. Conventional forms of therapy such as
This commercial test consists of a tray with two
cleaning the gingival pockets etc. often, experience
test wells for each tooth, and appropriate reagent
has shown, fail to be effective. An American
for conducting the test. The test involves collection
research team was able to show for the first time
of GCF with the filter paper strip which is then
that these patients to a disproportion extent (> 50
placed in tromethamine hydrochloride buffer. A
%) had a genetic defect in a certain component of
substrate reaction mixture containing 1-aspartic and
the immune system. This leads to over-production
α-keto-gluteric acid is added to the sample and
of an important local inflammatory mediator in the
allowed to react for ten minutes. In the presence of
immune system, namely interleukin-1 (IL-1). The
AST, the Aspartate and α keto-gluteric acid are

INTERNATIONAL DENTAL JOURNAL OF STUDENT’S RESEARCH| April 2016 | Volume 4| Issue 1

 30

over production of IL-1 leads to a strong immuno- References

response in the bone and connective tissue even 1. Savage A, Kenneth A., Moles R., Needleman,
when only small amounts of bacteria are present. Ian. "A systematic review of definitions of
As a result, a hyper-activation of so called periodontitis and methods that have been used to
osteoclasts can be detected which themselves then identify this disease". J Clin Periodontol 2009; 36
cause an aggressive bone resorption. (6): 458–467.
2. Armitage G C. Periodontal diagnosis and
Genetic Principals of the GenoType® PST® classification of periodontal disease.
Two polymorphisms within the IL-1 gene cluster Periodontol2000 2004; 34: 9-21.
show a close association with periodontitis: 3. Loesche W. Chemotherapy of dental plaque
1. Interleukin 1A gene, position -889 infections. Oral Sci Rev 1976;9:65-107.
2. Interleukin 1B gene, position +3953 4. Slots J, Bragd L, Wikstrom M, Dahlen G. The
Within both polymorphisms allele 1 harbors a occurrence of Actinobacillus
cytidin (C), whereas allele 2 carries a thymidin (T) actinomycetemcomitans, Bacteroides gingivalis
at the respective position. In particular, when both and Bacteroids intermedius in destructive
genes carry allele 2 a strong over-production of the periodontal disease in adults. J Clin Periodontol
local inflammatory mediator, interleukin-1 will 1986;13:570-577.
occur. 5. Sandmeier H, Van Winkelhoff AJ, Bar K, Ankli
The GenoType® PST® detects the corresponding E, Maeder M, Meyer J. Temperate bacteriophages
allele combination in patients allowing an are common among Actinobacillus
evaluation of the individual periodontitis risk and actinomycetemcomitans isolates from periodontal
future strategies for therapy. pockets. J Periodontol Res 1995;30:418-425.
PST (Genetic Susceptibility Test) is the first and 6. Christersson LA, Zambon J, Dunford R, Grossi,
only genetic test which analyzes two IL-1 genes for Genco R. Specific subgingival bacteria and
variations that identify an individual's diagnosis of gingivitis and periodontitis. J Dent Res
predisposition for over expression of inflammation 1989;68:1633-1639.
and risk for periodontal disease.IL-1genetic 7. Chapple I L. Periodontal diagnosis and treatment
susceptibility may not initiate or cause the disease – where does the future lie? Periodontology 2000
but rather may lead to earlier or more severe 2009; 51: 9-24.
disease. 8. Chapple I L C, Matthews J B, Thorpe G H et al.
Indications for the GenoType® PST® test: A new ultrasensitive chemiluminescent assay for
1. Patients exhibiting aggressive, therapy-resistant the site-specific quantification of alkaline
periodontitis for individual therapy planning phosphatase in gingival crevicular fluid. J
2. Patients with established periodontitis and loss of Periodontal Res 1993: 28: 266– 273.
attachment for progress assessment 9. Dahlin G. Role of suspected
3. Relatives of PST®-positive patients for risk periodontopathogens in microbiological monitoring
assessment before major restorative therapy and of periodontitis. Adv Dent Res 1993;7:163-174.
optimization of prophylaxis and recall interval. 10. Slots J, Ashimoto A, Flynn MJ, Li G, Chen C.
Detection of putative periodontal pathogens in
Conclusion subgingival specimens by 16S ribosomal DNA
In Periodontology, the success of any treatment is amplification with the polymerase chain reaction.
dependent upon the accuracy of the initial Clin Infect Dis 1995;20:S304-S307.
diagnosis. At present, the majority of chronic 11. Van Arsdell SW, DiFronzo F, Backman
periodontitis cases can be adequately managed KC, Mahler PH. Selling biotechnology in the
using existing diagnostic methodology, although it dental medicine marketplace: the OmniGene
is clearly more desirable to be able to diagnose Diagnostics DNA probe tests for periodontal
“active disease” as soon as it occurs, rather than pathogens. Technol Health Care. 1996
months later. There is an ongoing transition in Sep;4(3):339-46.
periodontal disease diagnosis from clinical 12. Carranza’s Clinical Periodontology, 9th
examination to more accurate advanced diagnostic Edition, newman , Advanced Diagnostic
methods. The availability of chairside diagnostic techniques- advances in microbiological analysis.
Test Kits will aid in early diagnosis and treatment. Chapter 34, 495-498.
It also helps in improving patient's compliance 13. Thomas Biju et al. "Chairside Diagnostic test
towards periodontal treatment considerations. The kits in Periodontics".JIDA 2007; 1(10)
newer commercially available chairside tests for 14. Mikx FH, Renggli HH. How sensible are
host and bacterial markers of periodontal disease bacteriological tests in periodontology? Ned
offer exciting prospects which would make the TijdschrTandheelkd. 1994 Dec;101(12):484-488.
monitoring of specific sites an attainable goal in 15. Ellen RP, Galimanas VB. Spirochetes at the
near future. forefront of periodontal infections. Periodontology
2000, 2005; 38: 13-32.

INTERNATIONAL DENTAL JOURNAL OF STUDENT’S RESEARCH| April 2016 | Volume 4| Issue 1

 31

16. Lõesche WJ. Comparison of the benzoyl- crevicular fluid. J Periodont Res 1993;28:266-273.
DLarginine- naphthylamide (BANA) test, DNA 27. Persson G, De Rouen T, Page R. Relationship
probes, and immunological reagents for ability to between levels of aspartate aminotransferase in
detect anaerobicicic periodontal infections due to gingival crevicular fluid and active tissue
Porphyromonas gingivalis, Treponema denticola destruction in treated chronic periodontitis patients.
and Bacteroides forsythus. J. Clin Microbiol. 1992; J Periodont Res 1990;25:81-87.
30: 427-433. 28. Chambers D, Imrey P, Cohen R, Crawford J,
17. Lõesche WJ, Giordano J, Soehren S, Alves M, Mcswiggin T. A longitudinal study of
Hutchinson R, Rau CF, Walsh L, et al. The non- aspartate aminotransferase in human gingival
surgical treatment of periodontal patients. Oral crevicular fluid. J Periodont Res 1991;26: 65-74.
Med Oral Surg Oral Path. 1996; 81: 533-543. 29. Kornman K, Crane A. The interleukin-1
18. Lõesche WJ, Taylor GW, Giordano J, genotype as a severity factor in adult periodontal
Hutchinson R, Rau CF, Chen Y-M, et al. A logistic disease. J Clin Periodontal 1997;24;72-77.
regression model for the decision to perform access
surgery. J. Clin Periodontol. 1997; 24: 171-179.
19. Bretz W, Loesche W. Characteristics of
Trypsin- Like Activity in Subgingival Plaque
Samples,.J. Dent. Res. 1987; 66: 1668-1672.
20. Essential of periodontology, Sahitya Reddy S,
microbiological diagnostic aids in periodontology,
chapter-46, page 467-474.
21. Laughton B, Syned S, Loesche W. API ZYM
system for identification of Bacteroides ssp.,
Capnocytophagia ssp., and spirochaetes of oral
origin. J Clin Microbial 1982;15:97-127.
22. Loesche W, Syed S, Stoll J. Trypsin-like
activity in sub-gingival plaque: A diagnostic
marker for spirochetes and periodontal disease? J
Periodont 1987;58:266-273.
23. http://www.e-dental.com/doc/periodontal-
probe-0001.
24. Armitage G, Jeffcoat M, Chadwick D et al.
Longitudinal evaluation of elastase as a marker for
the progression of periodontitis. J Periodontol
1994;65; 120.
25. Hemming K.W, Griffiths G.S. and Bulman J. S.
Detection of neutral protease (Periocheck) and
BANA hydrolase (Perioscan) compared with
traditional clinical methods of
diagnosis and monitoring of chronic inflammatory
periodontal disease. J Clin Periodontol 1997: 24:
110-114.
26. Chapple I, Matthews J, Thorpe G, Glenwright
H, Smith J, Saxby M. A new ultrasensitive
chemiluminescent assay for the sitespecific
quantification of alkaline phosphatase in gingival

INTERNATIONAL DENTAL JOURNAL OF STUDENT’S RESEARCH| April 2016 | Volume 4| Issue 1