Background: Inflammatory periodontal diseases are found in many dentate individuals, but therapists and researchers who assess disease activity have had to rely on external clinical signs and symptoms to ascertain the health of the subgingival periodontal tissues. However, by using an endoscope in the subgingival environment, the therapist can see the relationship of subgingival tooth-borne accretions to signs of inflammation in the pocket wall. This study explored those relationships via the endoscope. Methods: Twenty-six patients with moderate to severe periodontitis were chosen. The study visit involved a standardized, masked examinerwho gathered data on the external gingival index, probing depth, gingival recession, and clinical attachment level. A second standardized examiner, masked to the findings of the first, used a dental endoscope. A set of indices (endoscopic biofilm index, endoscopic calculus index, and endoscopic gingival index) specifically developed for subgingival parameters was used. A fixation stent ensured that the periodontal probe and the endoscopic explorer traveled along the same path. Results: A statistically significant relationship was found between deposits of subgingival calculus covered with biofilm and inflammation of the pocket wall, as measured by color change. In >60% of the cases, this inflammation was associated only with biofilm over deposits of calculus, not biofilm alone. Only subgingival calculus was statistically significant in relation to the positive traditional gingival index. Conclusions: Deposits of subgingival calculus covered with biofilm were directly related to >60% of pocket wall inflammation as measured by increased redness of the pocket epithelium. This was in comparison to biofilm alone.
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