A Histological and Clinical Evaluation of Shallow and Deep Probing Depths

New and improved diagnostic aides are constantly being developed and deployed to improve our ability to correctly identify, diagnose and treat a variety of medical conditions. Despite several attempts at developing a new gold standard tool for the diagnosis of periodontal disease [1], dental professionals still largely, although not exclusively, rely on the periodontal probe and periodontal probing depth (PD) for the identification and classification of periodontal diseases. PD is commonly used to evaluate the presence or absence of periodontal disease, and PD values are relied on for the determination of periodontal disease severity[2,3]. To these authors’ knowledge, no clinical study has conclusively defined the healthy PD. Generally speaking, in the absence of gingival recession or enlargement, shallow PDs of 1-3mm are considered to be indicative of a healthy or normal periodontal sulcus. Sites with PD values of 4-6mm are considered moderately deep and indicative of early stages of periodontal disease. Ultimately, sites with PD values greater than 7mm are considered as deep sites, typically caused by advanced periodontal disease. As such, clinicians view sites with progressively larger PDs with increasing concern. The aim of this short commentary is to use evidence from histological and clinical studies to discuss the merits of considering a shallow probing depth as healthy and to highlight changes induced by periodontal disease that lead to deepening periodontal pockets. PD is defined as the distance from the gingival margin to the deepest part of the probable crevice. Historically, the terms PD and pocket depth were used interchangeably. In 1971, Listgarten noted that PD measurements only offer an estimation of the true pocket depth, as the probe tip routinely goes beyond the sulcus and into the attachment apparatus of the tooth [4]. He further suggested that the only way to measure the depth of the anatomical sulcus, or pocket, is through histological means. One of the first studies to examine the physiological attachment around healthy human teeth was carried out in 1961 by Gargiulo et al. In this study, Gargiulo defined the dentogingival complex as the physiological and functional supporting tissue of teeth[5]. Measurements were made along 325 surfaces of presumably healthy teeth in human cadaver jaws. They concluded that the dentogingival junction is composed of the junctional epithelium (formerly the epithelial attachment) and the connective tissue fibrous attachment. In the study, Gargulio measured the depth of the true gingival sulcus, the length of the junctional epithelium and the length of connective tissue attachment throughout various phases of passive eruption. The study found the average sulcus depth to be 0.69mm (range 0.61mm 1.71mm). The average length of the junctional epithelium was 0.97mm (range 0.71mm – 1.35mm), while the average length of the connective tissue attachment was 1.07mm (range 1.03mm – 1.07mm) [5](Figure 1). As such, assuming a periodontal probe could precisely measure the depth of a healthy sulcus, we would expect to get measurements ranging from 0.61-1.71mm. However, the anatomic sulcus or pocket depth rarely corresponds to the clinical PD measurement. The periodontal probe routinely goes beyond the sulcus and penetrates the coronal part of the junctional epithelium [6]. Even in periodontal health and in absence of inflammation, the periodontal probe penetrates the junctional epithelium by 0.5mm, stopping 0.4mm coronal to the termination of the junctional epithelium [6]. This increases the expected PD in healthy tissues to 1.112.21mm (1.11mm = 0.61mm +0.5mm; 2.21mm = 1.71mm + 0.5mm). Also, seeing that probing depth Quick Response Code www.idjsr.com

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