Advanced Diagnostics
Advanced Diagnostics
Dr.Smitha.K
Professor and Head,
Department of Periodontology,
Government Dental college and Research Institute,
Bangalore
QUESTION BANK
Introduction
Efficacy of diagnostic test
Limitations of conventional methods
Advances in Clinical diagnosis
Advances in Radiographic assessment
Advances in microbiologic analysis
Advances in characterizing the host response
New innovations
Conclusion
References
INTRODUCTION
Periodontal
pathogens
Host
Genetic response
Systemic Behavioural
Microbiologic
• Consideration should Immunologic
be given systemic
genetic
behavioural factors
•Periodontal probes
OTHERS
- Calculus detection system
- Periodontal Disease Evaluation System
- Gingival Temperature
- Tooth mobility
- Halitosis detection.
- GCF,Saliva quantification-Periotron
PERIODONTAL PROBES
•Gold standard
• Simonton (1925) and Box (1928) were among the first to
advocate the routine use of calibrated probes
• Periodontal probes are used primarily to detect and
measure periodontal pockets and clinical attachment loss.
PERIODONTAL PROBES
• Some probes are available in combination such as Goldmann Fox on one side with
round probe at the other end.
• Merritt and Gilmore probes are the only two probes, which are not having any
calibrations.
• A modified Merritt probe is available with calibration in single increments from 1-
10 mm.
• University of Michigan probe is marked with 3, 6 and 8 mm
calibration.
•Constant force or pressure sensitive probes, was developed by Gabathuler and Hassell
in 1971.
• True Pressure Sensitive (TPS) probe , Hunter 1994 ( VIVA CARE/VIVA
DENT)
• Disposable probing head
• 20 gm & 0.5mm dia.
•These probes have a visual guide and a sliding scale where two indicator lines meet
at a specified pressure.
Examples:
• Pressure probe (Vander Volden)
• Pressure sensitive probe (PSP)
• Borodontic probe
• Yeaple probe (used to assess degree of dentinal hypersensitivity)
In 1977, Armitage : Simple pressure-sensitive periodontal probe holder: to
standardize the insertion pressure.
In 1978, van der Velden presented the "Pressure Probe", which allowed
probing force to be adjusted.
- Cylinder & a Piston connected to a variable air pressure system
The electronic pressure-sensitive probe, allowing for control of
insertion pressure, was introduced by Polson in 1980.
Polson’s original design was modified: the probe is known as the
Yeaple probe, which is used in studies of dentinal hypersensitivity
(Kleinberg et al., 1994).
•Kalkwarf et al 1986:
Eg:
Foster-Miller probe
Toronto probe
Florida Probe
Inter probe
FOSTER MILLER PROBE
This probe was introduced by Birek et al. (1991) and Mc Culloch et al.
(1991) for measurements of attachment levels using the incisal or the
occlusal edges as landmarks.
The probe consists of a digital length gauge which is connected to a nickel
titanium wire 0.5mm in diameter enclosed in a polyethylene sheath.
The probe is propelled by air pressure into the gingival sulcus with a
regulated force.
The data is recorded by a microcomputer that is interfaced with the digital
length gauge.
• Reproducibility of the angulation of the probe is assured by the
incorporation of a mercury switch (Karim et al, 1990), because it forces
the examiner to hold the probe+/- 100 of a vertical position.
• Angulation within 30 degree
• Probinf forces from 0.1 N to 0.9 N
• It was modified for the measurement of probe velocity (Tessier et al
1994)
Adv:
• Consists of incorporated electronic guidance system to improve precision in probe angulation.
• It also estimates the biophysical integrity of the dentogingival junction by measuring intrapocket probing
velocity.
Disadv:
• It is difficult to measure second and third molars, and patients have to position their heads in the same place
to reproduce readings.
FLORIDA PROBE
The system includes a control unit, 2 memory cards ,hand piece, dot matrix
printer, foot switch, chart forms and disposable flexible probe tips.
The Florida probe & the Florida disk probe have a resolution of 0.1 mm,
while the Interprobe has a resolution of 0.5mm.
PAROMETER
FOURTH GENERATION PROBES: (THREE
DIMENSIONAL PROBES)
OCT, a relatively new imaging technique, can create high-resolution cross-sectional images of biologic structures by
scanning a lightly focused light beam across the tissue surface of interest.
Conceptually, OCT imaging has been compared to ultrasound scanning .Both techniques provide structural images
using backscattered energy.
However, unlike an ultrasound, which uses sound waves, OCT uses broad-band low-coherent NIR light sources that
provide considerable
penetration into tissue with no known detrimental biologic effects.
OCT takes advantage of the low-coherence length of broadband laser light and interferometric detection to create
images with resolutions of 10 μm in the axial direction and 20 μm in the transverse plane using relatively
inexpensive light sources and optics.
COLORVUE PROBES FOR GINGIVAL
PHENOTYPE
CHU’S ESTHETIC GUAGE
NON-PERIODONTAL PROBES
CALCULUS DETECTION SYSTEM
PERIOSCOPE
The fiberoptic endoscopy based technology for calculus detection is currently being used in
only one device, Perioscopy (Perioscopy Inc., Oakland, CA, USA).
Perioscopy is a minimally invasive miniature periodontal endoscope and is inserted into the
periodontal pocket for subgingival visualization of the root surface at magnifications of 24–
48x.
This system consists of a 10,000-pixel fiberoptic bundle with 1mm diameter surrounded by
multiple illumination fibers, a light source, an irrigation system and a display monitor with
liquid crystal.
This automated system aids in the visualization of the subgingival root surface, tooth
structure and residual calculus in real time. Also, the magnified images can be viewed on
the monitor in real time and images as well as videos can be saved in computer files.
DetecTar
• Visible red fluorescence emissions produced by calculus when excited with 405 nm violet light.
• Ultraviolet light (315–400 nm), violet light (405 nm) and visible blue light (400–420 nm) will all generate
fluorescence emissions in the visible red region. The major fluorophores are the porphyrins, particularly
protoporphyrin IX, which emits at 633 nm. This approach has been used for detecting mature deposits of
supragingival plaque and calculus.
COMBINED CALCULUS-DETECTION
AND CALCULUS-REMOVAL SYSTEMS
• Er:YAG laser has been considered the most promising for periodontal therapy ,
mainly due to its property to ablate soft and hard tissue without major thermal
side effects. -Er:YAG lasers (Keylaser 1 or 2; Kavo, Biberach, Germany)
• Keylaser 3 (Kavo, Biberach, Germany) is the only commercially
available device, which combines calculus detection and removal in a
feedback-controlled manner.
ADVANCED CALCULUS DETECTION
SYSTEM
• SUMMARY
• Organoleptic measurement
• Gas chromatography
• . Sulfide monitoring
• Chemical sensors
• Indirect methds-BANA
PERIODONTAL DISEASE EVALUATION
SYSTEM
Halitosis or Oral malodor is most often caused by Gram –ve anaerobic bacteria
which degrades the proteins and produce volatile sulphur compounds.
Periotron 8000 quantifies the volume of gingival fluid or saliva collected on filter paper.
It functions on the principle of capacitor (it measures the electrical capacitance of the
wet filter paper strip placed between the jaws of instrument)
Electrical field created by opposing charges on the jaws induces polarity of the molecules
which reduces the potential differences between plates and increases the capacitance.
Thus the higher the number of polar molecules between the jaws of periotron, the larger
capacitance and higher periotron scores.
Unkown fluid volumes on filter paper may determined from calibration graphs
constructed by using acurately measured quantities of fluid.
Ciantar m (1998), invastigated calibration characteristics and reliability of
periotron 8000.
Quantitative analysis was studied by recording a series of peritron reading
over a volume range of 0-1 microlt for each fluid. The results of the study
revealed that
1)Differences in calibration fluid composition are reflected in periotron
scores.
2) positioning of the filter paper strip should be standardised.
3) Calibration seems to be consistent over 1 week interval
ADVANCES IN RADIOGRAPHIC
TECHNIQUE
Dental Radiographs are traditional method to assess destruction of alveolar
bone.
Primary criterion for bone loss is the distance from CEJ to the alveolar
crest and distance more than 2 mm is considered as the bone loss.
LIMITATIONS OF CONVENTIONAL
RADIOGRAPHY
Radiographs help assess the past diseases activity they do not reflect
the current disease activity.
There needs to be substantial amount of mineral loss (30-50%) before
bone resorption can be detected.
Misdirection of the central ray of the X-ray beam as well as exposure and
processing errors further limit accuracy.
Digital radiography utilizes digital detectors and they serve as a viable alternative to film-
based imaging.
Uses a Charge Couple Device (CCD) or This method uses a phosphor luminescence
CMOS sensor linked with fiberoptic or plate, which is a flexible film like sensor
other wires to computer system placed intraorally & exposed to
conventional x-ray tube.
CCD receptor is placed intraorally as
traditional films , images appear on a A laser scanner reads the exposed plates &
computer screen which can be printed or reveals digital image data.
stored
Direct Digital Imaging
Components
•X-ray source
•an electronic sensor,
•A digital interface card,
•a computer with an analog to- digital
converter (ADC),
•a screen monitor, software, and a printer.
sensor (CMOS-APS).
latest version
Trophy has released a wireless version of
their RVG intraoral sensor named the RVG
6500.
•Mouyen F et al (1989):
•The RVG system when compared with conventional uses considerably reduced levels
of radiation to produce an image immediately after exposure..
Adosh L in 1997 in a comparative study for marginal bone between RVG and after
surgical exploration presented that Majority showed difference of less than 0.5 mm
between two techniques
Video camera measures the light transmitted through a radiograph and the signals
from the camera are converted into gray-scale images.
Advantages:
1.CT completely eliminates the superimposition of images of structures outside
the area or sit of interest.
2.Second because of the inherent high contrast resolution of CT differences
between tissues that differ in physical density by less than 1% can be
distinguished,conventional radiography requires a 10% difference in physical
density to distinguish between tissues.
3.Data from a single CT imaging procedure consisting of either multiple
contiguous or one helical scan can be viewed as an image in the axial ,coronal
or saggital plane
LIMITATIONS OF CT
Cone Beam CT like the conventional dental X-ray units, can also be used to generate
3-D CT images at a much lower radiation dose.
Utilizes cone shaped source of ionizing radiation & 2D area detector fixed on a
rotating gantry .
Multiple sequential images are produced in one scan
Conventional CT scanners make use Utilize a cone beam, which radiates from the x-ray
of a fan-beam and Provides a set of source in a cone shape, encompassing a large
consecutive slices of image volume with a single rotation.
LCT generates exquisite image detail in 3-D while retaining the advantages
of reduced patient dose and reduced cost. This makes the use of LCT
particularly suited for dental radiography.
Adv:
It offers the best resolution of tissues of low inherent contrast.
No ionizing radiation is involved
Since the region of the body imaged is controlled electronically,
direct multiplanar imaging is possible without reorienting the
patient.
Disadv:
Expensive
Requires considerable scan time for high resolution images
May be claustrophobic for the patient
The potential of causing movement of ferromagnetic metals in the vicinity
of the imaging magnet
Metals used in dentistry for restorations or orthodontics will not move but
may distort the image in their vicinity.
Schara et al 2009
In an invitro study evaluated the used the use of MRI to characterize
inflammation and healing process in periodontal tissues
It was concluded that MRI can characterize the type and healing process of
inflammation
PHOTODENSITOMETRIC ANALYSIS
TECHNIQUE
It is based on the absorption of a beam of light by the radiographic film
which shows the image of an aluminum scale.
It also has the ability to transform density reading into 1mm of aluminum
equivalent.
Patient has
mobility or
In the absence altered Implant
of clinical signs sensation use retrieval
use IOPAS or cross sectional
OPGs imaging CBCT
/CBCT
RADIOGRAPHS IN PERIODONTAL DISEASE
DIAGNOSIS AND MANAGEMENT
• Culture methods can only grow viable bacteria; therefore, strict sampling and
transport conditions are essential.
• Moreover, some of the putative pathogens, such as Treponema sp. and Tf, are
very fastidious and difficult to culture. The sensitivity of bacterial culturing can
be rather low, especially for non-selective media, with detection limits averaging
103-104 bacterial cells, and therefore, low numbers of a specific pathogen in a
subgingival sample will be undetected.
• However, most of the putative periodontal pathogens like Aa, Pg, Tf; which are
nonmotile and therefore this method cannot identify these species.
AIM: the purpose of this study was to determine if a periodontal abscess could be differentiated from
an endodontic abscess by the types and proportion of microorganisms found in the abscess exudate in
darkfield microscopic examination.
CONCLUSION: In periodontal abscesses the occurrence of spirochetes ranged from 30 to 60%,
whereas in endodontic abscesses the range was 0 to 10%. Thus, the percentage of spirochetes as seen
by darkfield microscopy may be of value in the differential diagnosis of periodontal and endodontic
abscesses.
MI CROBI AL A NA LY S I S I N P ERI ODONTICS AIMS TO:
• Here antigenic determinants in patient specimens are immobilized and fixed onto
glass slides with formalin, methanol, ethanol or acetone. Monoclonal or polyclonal
antibodies conjugated (attached) to fluorescent dyes are then applied to the specimen.
• After appropriate incubation and washing, the slide is viewed using a microscope
equipped with a high-intensity light source (usually halogen) and filters to excite the
fluorescent tag.
• Zambon et al. showed that this technique was comparable with bacterial
culture in its ability to identify Aa and Pg in subgingival plaque samples.
In fact, IFA demonstrated a higher sensitivity when compared with culture,
probably because of a lower detection limit. Comparative studies indicated
that the sensitivity of these assays ranged from 82% to 100% for detection of
Aa and from 91% to 100% for detection of Pg, with specificity values of 88%
to 92% and 87% to 89%, respectively (Zambon et al1985, 1986).
IMMUNO PRECEIPITATION
Rapid identification
Principle is labelling bacterial cells with both species-specific antibody
and a second fluorescein-conjugated antibody
This suspension is introduced into flowcytometer, which separates
bacterial cells into an almost single cell suspension
Limitation is sophistication and cost involved with this procedure
FLOW CYTOMETRY
Latex beads coated with species specific AB when beads come in contact with specific
species in sample they bind and agglutination occurs clumping of beads is visible test
positive.
There are 2 types of latex agglutination test:
1. The indirect assay
2. The inhibition assay
• The indirect assay is the most common test for bacteria. The antibody is
bound to latex. When a suspension of plaque sample is mixed with the
sensitized latex and gently agitated for 3-5 minutes agglutination or clumping is
indicative for positive result of the bacteria being tested.
• The latex inhibition assay is based on the principal of inhibiting the expected
agglutination reaction between known antigen and known antibody as a result of
competition. (Nisengaurd et al 1992).
• THIS STUDY DESCRIBE THE development, characterization, and initial
application of latex agglutination assays for periodontal pathogens.
Latex reagents were prepared by sensitization of latex microspheres
with rabbit IgG antibodies to either Actinobacillus
actinomycetemcomitans, Porphyromonas gingivalis, or Prevotella
intermedia.
• Advantages:
Quantitative estimate of target species
Not requiring stringent sampling and transport
methodology
Higher sensitivity and specificity than bacterial culturing
for A.a, P.g and T.f.
Disadvantages:
Limited to the number of antibodies tested
Not amenable for antibiotic susceptibility
Lack the evidence of well controlled clinical studies
Enzymatic Methods Of Bacterial Identification ( BANA).
• Tf, Pg, the small spirochete Td and Capnocytophaga species share a common
enzymatic profile, since they all have a Trypsin-like enzyme in common.
• The activity of this enzyme can be measured with the hydrolysis of the colourless
substrate N-benzoyl-DL-arginine-2-naphthylamide (BANA).
• A diagnostic kit has been developed using this reaction for the identification of this
bacterial profile in plaque samples (Perioscan).
• Principle of BANA test
• Peptidases of these three bacterial species (T. denticola, P. gingivalis, and B.
forsythus) can hydrolyze the peptide analog N-benzoyl-DLarginine-2 naphthylamide
(BANA).
• One of the hydrolytic products of this reaction is beta naphthylamide, which reacts
with a reagent, which is imbedded in the upper strip of the test, producing a
permanent blue color.
• The BANA test is a plastic strip to which two separate reagent matrices are attached.
• The lower white reagent matrix is impregnated with N benzoyl- DL-arginine-B-
napthylamide (BANA). Subgingival plaque samples are applied to this lower matrix.
• The upper buff reagent matrix contains a chromogenic diazo reagent, which reacts
with one of the hydrolytic products of the enzyme reaction, forming a blue color. The
blue color appears in the upper buff matrix and is permanent. The intensity of the
color determines whether it is a positive or weak reaction.
• Loeshe et at in 1986 proposed the use of BANA reaction in subgingival plaque samples.
• Using probing depths as a measure of periodontal morbidity, they showed that shallow
pockets (2-3mm)exhibited only 10% positive BANA reactions, whereas deep pockets
(7mm) exhibited 80-90% positive BANA reactions.
Loesche WJ. The identification of bacteria associated with periodontal disease and dental caries by enzymatic methods.
Oral Microbiol Immunol. 1986 Nov;1(1):65-72.
• Loesche et al. 1992 tested the diagnostic utility of the BANA test compared with
culture, IFA, ELISA and DNA probes, rendering similar results with regard to
sensitivity and accuracy (above 90% to detect combination of these organisms).
Loesche WJ, Lopatin DE, Giordano J, Alcoforado G, Hujoel P. Comparison of the benzoyl-DL-arginine-naphthylamide
(BANA) test, DNA probes, and immunological reagents for ability to detect anaerobic periodontal infections due to
Porphyromonas gingivalis, Treponema denticola, and Bacteroides forsythus. J Clin Microbiol. 1992 Feb;30(2):427-33.
DISADVANTAGES OF BANA
• A DNA probe is a fragment of nucleic acid that can seek out and bind itself to other
complementary sequences of DNA, thus forming the double helix structure found by
nature.
• The DNA library included probes for A.a., P.gingivalis, C.rectus, E.corrodens,
F.nucleatum,and T.denticola.
• These probes can detect bacteria as few as 102 to 104 cells.
• The plaque sample is first denatured to obtain single strain bacterial DNA &
this is isolated on nitrocellulose membrane. The specific labeled DNA probe
is incubated on the membrane to allow hybridization of the 2 single strains to
take place, which can be visualized via label in the probe.
DNA PROBES
• Advantages • Disadvantages
Very specific and determine Very expensive
phenotypic markers The minimal detection limits for
Has great specificity and sensitivity particular species are 103–105
Not affected by transport conditions cells
Do not require anaerobic conditions to The chairside diagnosis is not
be maintained possible
Can be done in dead bacteria and The cross reactivity by
they do not depend on bacterial oligonucleotide probes can occur
viability. Antibiotic sensitivity is not
possible.
OMNIGENE (DMDX)
• van Steenbergen et al found the DMDx detection method to possess 96% sensitivity and
86% specificity for spiked laboratory specimens of Aa and 60% sensitivity and 82%
specificity for laboratory specimens of Pg.
• For Pg, the sensitivity was 71% and the specificity 53%.
• With the Pado RNA probe test kit, four periodontal pathogens can be detected: Aa, Pg,
Tannerella Forsythia, and T. denticola.
• This test basically uses oligonucleotide probes complementary to conserved fragments of
the 16S rRNA gene that encodes the rRNA, which forms a subunit of the bacterial
ribosome.
• The detection threshold of this test is 103 for Aa and 104 for Pg, T. forsythia and T.
denticola.
• The detection frequencies found with this test indicated a low sensitivity of the Pado Test
4.5 method when compared to the checkerboard method.
Disadvantage:
• The Pado Test 4.5 seems to underestimate the number of positive sites/individuals
suggested by a high number of false negatives.
• The aim was to compare the detection frequency of periodontopathogens by
using the Pado Test 4.5 and checkerboard DNA-DNA hybridization
technique in chronic periodontitis patients.
• Thirty patients with chronic periodontitis were tested cross-sectionally with
DNA/RNA oligogenomic probe method (IAI Pado Test 4.5) and DNA/DNA
whole genomic probe (checkerboard) method.
• The detection frequencies observed for this test show a poor sensitivity and
the test appears to undercount the number of positive sites/individuals exposed
as a result of a large number of false negatives
MY PERIOPATH
• Socransky et al. (1994) developed this technique for the detection and levels of
40 bacterial species commonly found in the oral cavity.
• The DNA probes used in this technology are commonly be adjusted to permit
detection of 104 cells of each species, but can adjusted to detect 103 cells.
• The method requires sophisticated laboratory equipment and expertise, and it is highly
specific.
• These factors have not led to generalisation of this assay for diagnostic purposes.
• Papapanou et al. (1997) made a comparison of this method with culture for the identification
of subgingival bacteria. The checkerboard technology resulted in higher prevalence
figures for half of the species tested (Pg, Pi, Fn and Tf) and statistically significant higher
bacterial counts for the majority of the species. Both techniques rendered a reasonable degree
of agreement.
3. POLYMERASE CHAIN REACTION (PCR)
Disadvantage
• Small quantity needed for reaction may not contain the necessary target
DNA
• Plaque may contain enzymes which may inhibit these reactions.
EVALUSITE
• It is a real – time PCR for the quantitative determination of the six most important marker
organisms of periodontitis and peri- implantitis and the total bacterial load. (Jervoe-Storm et
al. 2005)
• The marker organisms are Agregatibacter actinomycetemcomitans, Porphyromonas
gingivalis, Tanerella forsythus, Treponema denticola, Fusobacterium nucleatum and
Prevotella intermedia.
• It combines high specificity with high sensitivity and a precise quantification.
• The detection limit, at 100 bacterial cells per type of pathogen, is far below the limits of
methods available.
• Making it highly sensitive.
ADVANCES IN CHARACTERIZING THE
HOST RESPONSE
Assessment of host response refers to the study of
mediators by immunologic or biochemical methods,
that are recognized as a part of individual’s response to the
periodontal infection.
TNF-alpha
IL-1 α
IL-1β
IL-6
IL-8
PGE2 (product of COX pathway)
Cross sectional studies have shown good correlation with disease status and severity but not
disease progression
In cases of untreated periodontitis concentration of PGE2 was found increased
.
HOST DERIVED ENZYMES
• Breakdown of collagen occurs by two different pathways:
• Intracellular
1. Aspartate amino transferases
2. Alkaline phosphatase
3. β- Glucuronidase
4. Elastase
• Extracellular
Matrix metalloproteinase's family (MMPs)
Tissue Breakdown Products
• Analysis of GCF obtained from sites with active periodontitis clearly shows
elevated levels of Hydroxyproline from collagen breakdown and GAGs
from matrix degradation.
• Osteocalcin and type-1 collagen peptides- progression of alveolar bone loss.
Biochemical test kits
Prognostik- to detect elevated levels of MMPs
Procedure:
The GCF sample strip is placed on a gel containing insoluble dye ‑labeled
collagen fibrils (remazo brilliant blue ‑collagen substrate powder) and incubated.
In the presence of neutral proteases (which diffuse from the strip into the gel),
the insoluble collagen‑dye complex is digested to release soluble dye ‑labeled
fragments, which diffuse back into the strip, turning it blue.
PERIOGARD
• The test involves the collection of GCF with the filter paper strip which is then
placed in tromethamine hydrochloride buffer. A substrate reaction mixture
containing 1‑aspartic and α‑ketoglutaric acid is added to the sample and
allowed to react for ten minutes.
• The addition of a dye such as fast red results in a color product, the intensity
of which is proportional to the AST activity in the GCF sample.
• The test is designed to be positive at >800 µIU of AST activity and negative
at values <800 µIU.
•
• The Pocket Watch detects elevated levels (>1200IU) of AST in GCF and is
used as an objective, biochemical test for diagnosing and monitoring the
disease activity, to determine when to treat, and also to evaluate the treatment
effectiveness.
POCKET WATCH
The GCF sample collected will be placed in a test tube containing 0.5 ml of a buffer at pH
7.4.
When the dip area of dipstick is placed in the extracted sample; the dipstick absorbs liquid,
which starts to flow up the dipstick.
When the sample contains MMP‑8, it binds to the antibody attached to the latex particles.
The particles are carried by the liquid flow if MMP‑8 is bound to them; they bind to the
catching antibody.
If the concentration of MMP‑8 in the sample exceeds the cutoff value for the test, a positive
line will appear in the result area
Some Commercial Tests under
development
ẞ- GLUCURONIDASE
A test system suitable for chairside use has been developed by Enzyme
System Products/Prototek of Dublin, California, USA.
This system contains the peptide substrates and the 7-amino trifluoro-
methylcoumarin (AFC) leaving group which is considerably more
sensitive than other fluorogenic leaving groups.
The use of the appropriate derivative of 7-amino-trifluoromethyl coumarin
(AFC) is used to detect proteolytic enzyme activity.
• Rapid measurement of levels of the collagen cleaving enzyme MMP-8 in saliva from
healthy and periodontally diseased subjects can be achieved.
• The hand-held IMPOD has been used to rapidly (3–10 minutes) measure the concentrations
of MMP-8 and other biomarkers in small amounts (10 ml) of saliva
GENETIC TEST KITS
• Periodontitis susceptibility trait test (PST)
• The periodontitis susceptibility trait test is the first genetic susceptibility test for severe
periodontitis.
• It is commercially available.
• It evaluates the simultaneous occurrence of allele 2 at the IL‑1α +4845 and 1β +3954 loci.
• IL‑1 genetic susceptibility may not initiate or cause the disease but rather may lead to
earlier or more severe disease.
• The IL‑1 genetic test can be used to differentiate certain IL ‑1 genotypes associated with
varying inflammatory responses to identify individuals at risk for severe periodontal disease
even before the age of 60.
MyperioID
• My PerioID test uses saliva to determine a patient’s genetic susceptibility to periodontal
diseases.
• It assesses patients who are at higher risk of more serious periodontal infections.
• This test requires the transportation of saliva samples to a laboratory for results.
Detects(from human DNA) genetic variation/polymorphism within the IL‑1 gene
IL‑1 is a major inflammatory mediator
30–35% of the US population has this genetic variation
IL‑1 positive individuals tend to have more aggressive and more severe infections
Determines patients that are most susceptible to severe disease, especially if the patients smoke
This genetic variation can increase risk for severe disease or tooth loss by 2–7 times when
present.
NUCLEIC ACID PROBE
• After all these years of intensive research, we still lack a proven diagnostic
test that has demonstrated high predictive value for disease progression,
has an impact on disease incidence - prevalence & is simple, safe , cost-
effective….