The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future

Abstract

Periodontal diseases comprise a group of globally prevalent, chronic oral inflammatory conditions caused by microbial dysbiosis and the host immune response. These diseases specifically affect the tooth-supporting tissues (i.e., the periodontium) but are also known to contribute to systemic inflammation. If left untreated, periodontal diseases can ultimately progress to tooth loss, lead to compromised oral function, and negatively impact the overall quality of life. Therefore, it is important for the clinician to accurately diagnose these diseases both early and accurately chairside. Currently, the staging and grading of periodontal diseases are based on recording medical and dental histories, thorough oral examination, and multiple clinical and radiographic analyses of the periodontium. There have been numerous attempts to improve, automate, and digitize the collection of this information with varied success. Recent studies focused on the subgingival microbiome and the host immune response suggest there is an untapped potential for non-invasive oral sampling to assist clinicians in the chairside diagnosis and, potentially, prognosis. Here, we review the available toolkit available for diagnosing periodontal diseases, discuss commercially available options, and highlight the need for collaborative research initiatives and state-of-the-art technology development across disciplines to overcome the challenges of rapid periodontal disease diagnosis.

Keywords: biomarkers; dental equipment; diagnostic imaging; oral diagnosis; periodontal diseases; periodontal probe.

Figure 1

(a) Schematic presenting the measurement of PD between the tooth and gingiva using a periodontal probe with distance markings. (b) Various types of commonly used manual periodontal probes and (c) specifications [19].

Figure 2

(a–c) Conventional 2D radiography. (a) Panoramic X-ray for capturing the entire mouth with an overall view. Reprinted with permission from [84]. (b) Periapical X-ray and (c) bitewing X-ray for evaluation of periodontal disease. Reprinted with permission from [85]. (d) Digital subtraction radiography for bone-regeneration assessment; (I) baseline radiograph, (II) after 12-month radiograph, and (III) subtraction of (II) from (I). Reprinted with permission from [86]. (e) Deep learning-based periodontal bone-loss diagnosis; (I) panoramic radiograph, (II) bone-loss lesion annotated by clinicians, and (III) bone-loss class activation map highlighted by the deep-learning-based system. Reprinted with permission from [87]. (f) CBCT software interface including pan-map (top-right), horizontal section (top-left), vertical sections (bottom-right) and 3D reconstructed model (bottom-left). Reprinted with permission from [88]. (g) The depth and volumetric measurement of the periodontal pockets using CBCT. Reprinted with permission from [89]. (h) 3D volumetric reconstructive CBCT image obtained from a patient with aggressive periodontitis. Reprinted with permission from [90].

Figure 3

Advancement of chairside periodontal diagnostic tools and their future directions.