Where recession is present, the addition of the recession and pocket measurements gives the attachment loss (AL) measurement for that particular tooth surface. Root planing. Based on a sample of 3,742 adults participating in the first national survey to use a full-mouth examination protocol for diagnostic accuracy (NHANES 2009-2010), a prevalence of periodontal disease of 47.2% was estimated for US adults aged 30 years or older. FOIA Total calculus removal: an attainable objective? Breininger DR, O'Leary TJ, Blumenshine RV. Clinical and biochemical effect of laser as an adjunct to non-surgical treatment of chronic periodontitis. Buchanan SA, Robertson PB. Shallow sites had greater surface area of calculus than moderate and deep sites. Correct sharpening technique may differ depending on the type of hand instrument selected (eg, scaler or curette) and is consequently technique sensitive. Blunt/incorrectly sharpened instruments may lead to ineffective calculus removal and may result in excessive forces being applied to the root surface, and a danger of metal fatigue or fracture as well as risk of excessive tooth surface removal. After use, instruments should beinspected for damage. Torfason T, Kiger R, Selwig KA, Egelberg J. Ann Periodontol. A Systematic Review. Risk indicators for alveolar bone loss. Detection of subgingival calculus is critical for successful treatment outcome in the management of periodontal patients. J Periodontol. This study indicates the difficulties in clinically determining the thoroughness of subgingival instrumentation. College of Dentistry, Gainesville, Florida, Rodrigo Neiva, DDS, MS Create and use an extended grasp for improved access and stroke production. The light returned off the root surface is picked up by a fiber optic lead and converted into an electrical signal for analysis. HHS Vulnerability Disclosure, Help Increased prevalence of disease was noted for Mexican American and African Americans, older individuals, smokers, men, and those with lower educational attainment and lower socioeconomic status.10, Given that therapy for bacterial removal is necessary/desirable to engender a healthy gingival environment, it is practical to address methods for achieving this goal along with their effectiveness. I. Bethesda, MD 20894, Web Policies Isidor F, Karring T, Attstrom R. The effect of root planing as compared to that of surgical treatment. Hence, calculus should be accurately detected and thoroughly removed for adequate periodontal therapy. 8. Sherman PR, Hutchens LH Jr, Jewson LG, et al. The https:// ensures that you are connecting to the Perform exploration techniques to detect residual calculus deposits. Obviously, clinical diagnosis of the presence of calculus is significantly affected by restricted access, probing depths, root surface texture, root anatomy, and anatomical aberrations. Accurate assessment plays a key role in determining diagnosis and selecting appropriate therapy. It will not be long before this trend takes over from analogue systems in the veterinary dental field. 051X.2008.01274.x. Impact of . FOIA 1990;61(1):3-8. Careers. official website and that any information you provide is encrypted 2023 - Decisions in Dentistry All Rights Reserved. Periodontal probe with graduations up to 10 mm; sickle explorer other end, Protective eyewear with or without magnification. J Periodontol. It's often recommended that people floss once a day to remove plaque and bacteria from between the teeth. Save my name, email, and website in this browser for the next time I comment. The learning curve to use the DetecTar is quick and easily achieved. Harrel SK, Wilson TG Jr., Tunnell JC, Stenberg WV. Dental care availability was associated with moderate and severe clinical attachment loss (CAL) . Although bacterial virulence factors, such as endotoxin, do attach to and penetrate cementum, removal is possible with conservative instrumentation.13 Consequently, aggressive removal of diseased cementum (root planing) for the purpose of elimination of bacterial endotoxin is no longer routinely recommended.14 However, this terminology persists in the nomenclature and everyday discussion of treatment approaches. In the USA, the veterinary technician is trained to perform this step as well as take radiographs and perform the dental scale and clean. J Periodontol. Scaling and root planing with and without periodontal flap surgery. J Clin Periodontol. Flossing. Verification phase. A former associate professor at the Herman Ostrow School of Dentistry at the University of Southern California, Sottosanti is a fellow of the American College of Dentistry and Pierre Fauchard Academy, Florida Looks to Ease Its Access-to-Care Problem, Free App Helps Those With Autism Improve Their Oral Health, Making the Most of the New Periodontal Classification System, Effectively Addressing External Root Resorption, Developing a Comprehensive Care Plan for Patients, A Natural Approach to Periodontal Therapy. In pockets of 3 to 5 mm, the chances of failure are greater than success, and in pockets larger than 5 mm, the chance of failure to remove all deposits dominates. Usually record 6 probing depths for large and important teeth such as canine, carnassial teeth, and molar teeth. Furcation entrance architecture. Trenter SC, Walmsley AD. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). found no statistical differences in dental calculus clearance rates between the two methods when initial PPD was 0-3 mm, 4-5 mm, or, 6-12 mm. Dimensions of Dental Hygiene is a monthly, peer-reviewed journal that reconnects practicing dental hygienists with the nations leading educators and researchers. In fact, the removal of all subgingival plaque and calculus is unlikely to occur when mean probing depths is = 3.73 mm.13. Light signal upon detection by DetecTar. They aresimilar in size and diameter. The .gov means its official. T-tests were used to determine within-subject differences between Perioscope and tactile measures, and changes in measures between visits. 1 = Marginal gingivitis, mild swelling, some colour change, no BOP 15. Powered instruments were associated with a time advantage and no major difference in the frequency or severity of adverse effects between the modalities was found. F3 = Probe goes all the way through buccolingual crown width of multirooted tooth, M1 = Slight mobility > 0.2 mm, less than 0.5 mm Nevertheless, no matter who performs it, advanced therapy necessitates a level of care equivalent to that expected of a fully trained periodontist.2. Potential hazards associated with use of powered instruments were reviewed by Trenter and Walmsley.16 Possible complications included the potential for thermal pulp damage; the authors concluded powered scaling should not be considered without irrigation, with a flow rate in the region of at least 20 to 30 mL/min. Ely HC, Abegg C, Celeste RK, Pattussi MP. Examples and key features of sonic and ultrasonic instruments are presented in Table 2. Single versus repeated instrumentation. The role of dental calculus and other local predisposing factors 8. 2. Periodontal Maintenance. This can be maintained through use of polishing stones, whose surface is made of abrasive crystals harder than the metal being sharpened. This distinction can be important because gingivitis is easily addressed, whereas persistent periodontitis calls for additional scaling and root planing (SRP) and frequently advanced periodontal therapy. Flossing is another popular way to remove calculus. Axelsson P, Nystrm B, Lindhe J. For peri-implantitis cases, assessed with peri-implant bone loss, referral/consultation with a periodontist may be prudent. Digital radiography has already started to replace screen film/darkroom processing in many veterinary teaching universities in Australia. Advanced Therapy. Nordland P, Garrett S, Kiger R, Vanooteghem R, Hutchens LH, Egelberg J. The use of a plaque disclosing dye (IC plaque, iM3) on the teeth will demonstrate to the owner the extent of the problem. Less common tools include furcation probes and CT imaging. Lee N Sheldon, DMD, has provided comprehensive implant, periodontic, and full-mouth rehabilitation dental services for more than 30 years in his private practice in Melbourne, Florida. J Clin Periodontol. 2002;29 suppl 3:72-81; discussion 90-91. However, the ability to clinically detect initial and residual subgingival calculus using subjective tactile sense with a probe or explorer has come into question many times. Elongated shanks may also allow improved access in deeper pockets (5 mm); positioning and fulcrum must be good to avoid over-stressing the instrument in use. Its use standardized the quality of detection among clinicians and was most efficient when subjective clinical judgment was avoided. 2002;29 suppl 3:92-102; discussion 160-162. Department of Periodontology, University of Florida Two types are recognized: magnetostrictive and piezoelectric. 2022 Jul;14(Suppl 1):S841-S844. . Kettenbach Introduces Visalys Fill and Visalys Flow Composites, Microcopy Introduces the NeoDiamond X-Class, Zest Dental Solutions Launches Fully Guided Surgical Kit for Full-Arch Solutions. Furcation areas exhibit a complex and varying anatomy, and furcation entrances are often a dimension smaller than traditional curette tips.24 Access is consequently a key issue in providing effective treatment and has led to modifications in instrument design over time, particularly the development of smaller ultrasonic tips which may be favored as instruments of choice for furcation sites.19. 13. The DetecTar is used like a conventional periodontal probe, using a 10-15angulation with slow vertical sweeping strokes along the root surface (Figure 2). Laser-based periodontal therapy is sometimes promoted as a stand-alone substitute for closed SRP or as an adjunct to traditional SRP. Rigid Gracey curettes are more normally used for medium-to-heavy calculus removal. 3 = Heavy calculus covering > 2/3 of buccal tooth surface and extending subgingivally, 0 = Normal gingiva Interpretation of clinical charting should account for the limitations of probing. An LED light is shined from the tip of the probe (Figure 3). 1990 Jan;61(1):3-8. doi: 10.1902/jop.1990.61.1.3. The use of modified probe tip designs with a controlled-force technique may also offer the potential for improvement of comfort level of patients undergoing periodontal probing. Calculus was found on 376 surfaces with a mean percent surface area of 3.13%. The measurement (to the nearest mm) is taken from the cementoenamel junction to the free gingival margin. The chances of detecting and removing all subgingival calculus are fairly good if the probing depth is <3 mm. Inspection of the intraoral structures should follow, including the hard and soft tissues with the focus on the dentition, gingiva, mucosa, tongue, tonsils and occlusion. Oligodontia/supernumerary teeth, especially in breeds with a family history of missing or extra permanent teeth, 9. MeSH II. Larsen C, Barendregt DS, Slot DE, et al. Missing, rotated, and fractured teeth; probing depths (up to 6 points per tooth) of gingival recession; and hyperplasia . The effectiveness of subgingival scaling and root planing. 21. J Clin Periodontol. 2 = Penetration into dentine Vaia E, Bozzini V, Nicol M, Riccitiello F. J Clin Periodontol. J Periodontal Res. Endodontic disease including apical pathology, pulp exposures, and draining fistulae, 3. It can also be used post-root debridement to assess the presence of residual calculus. Figure 5. In humans, the severity of periodontitis is based on a number of findings, including tooth mobility, BOP, AL, furcation involvement, purulent discharges from pockets, and tooth pain associated with percussion or thermal sensitivity testing. Determine the level of calculus, as per the CI above, 3. One hundred one extracted teeth with 476 instrumented tooth surfaces were evaluated stereomicroscopically for the presence of calculus and the percent surface area with calculus was determined by computerized imaging analysis; 57% of all surfaces had residual microscopic calculus and the mean percent calculus per surface area was 3.1% (0 to 31.9%). The time needed for future debridement appointments can be accurately planned depending on the general location and quantity of calculus assessed at the time of examination. The effectiveness of subgingival scaling and root planing. Decisions in Dentistry - A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists. Lubrication (eg, orange solvent) should be used before sharpening to decrease clogging of the abrasive surface from metal particles. found no statistical differences in residual dental calculus rates between ultrasonic and manual subgingival scaling with initial PPD at 5-6 mm, 7-8 mm or > 9 mm. A number of practices utilise trained veterinary technicians and nurses to do the initial oral examination. The average percentage of accurate detections of clinically identifiable calculus tends to be affected by clinical conditions and the experience of the clinician. Nonsurgical instrumentation may be carried out using a variety of instruments, which may be broadly divided into hand instruments and powered instruments. 1990 Jan;61(1):9-15. doi: 10.1902/jop.1990.61.1.9. 9. The clinical response such as reduction in bleeding and gingival inflammation scores, gain in calibrated attachment level (CAL), reduction on probeable pocket depth (PPD), and closure of the pocket if the root is rendered completely free of all deposit, are also indicators of how well the root is instrumented. There is an increasing uptake of digital radiography in human dentistry also. An instrument that can objectively detect subgingival deposits is likely to improve the objectives of subgingival debridement by allowing more accurate detection of residual calculus deposits and the establishment of a reliable end point to periodontal therapy. 16. Depending on the treatment performed, patient reevaluation should occur at 6 weeks to 3 months post-therapy. 1979;14(3):239-243. Not only does quality self-care help preserve oral health, it also facilitates ongoing diagnoses and disease management. J Periodontol. This periodontal therapy removes calculus and roughness from the root surfaces of diseased (periodontally involved) teeth. 5. Experimental Gingivitis in Man. Probing provides a practical way of assessing periodontal health or disease. Scaling and root planing: removal of calculus and subgingival organisms. Badersten A, Nilveus R, Egelberg J. Grossi SG, Genco RJ, Machtei EE, et al. J Periodontol. Relative effects of plaque control and instrumentation on the clinical parameters of human periodontal disease. 2nd ed. In: The Scientific Way: Synopses of Clinical Studies. Examples include: Rx System II Periodontal Set (Rx Honing Machine Corporation, www.rxhoning.com) and the Sidekick Sharpening Kit (Hu-Friedy). Paris, France: Quintessence International; 2007. Differentiation of these instruments is primarily on the basis of vibration frequency. Examples include the use of Swivel inserts (Hu-Friedy), which remove the need to adjust magnetostrictive tips during use; longer grips for decreased hand fatigue; elongated tips for improved access; and the use of thinner, streamlined, and lightweight tips. The residual calculus paradox J Periodontol. 2008;35(8 Suppl):286-291. doi: 10.1111/j.1600- 2008;35(5):405-414. doi: 10.1111/j.1600-051X.2008.01225.x. Common Indices Used in Veterinary Dentistry, Can be generalised or localized Yukna et al. Bacteria play a crucial role in disease etiology and their removal represents the focus of much of the strategy for treatment of periodontal diseases. Harrel can be reached at [emailprotected]. Probing pressure, a highly undervalued unit of measure in periodontal probing: a systematic review on its effect on probing pocket depth. 2006;77(9):1598-1601. A Comparative Clinical Study to Assess the Role of Antibiotics in Periodontal Flap Surgery. Mandibular 1st molar (cat) ends in 09, i.e., right maxillary premolar 4 is numbered 108, Labial - the surface toward the lips (applies to incisors, canines), Incisal - toward the tip of the tooth (for incisors, canines), Distal - surface away from midline of animal, Interproximal - surface between two teeth, Mesial - surface toward rostral midline of animal, Occlusal - biting surface of tooth (applies to maxillary molar 1 and 2 in dogs), Palatal - surface of tooth toward hard palate, Supragingival - above the free gingival margin (gum line), Subgingival - below the free gingival margin (gum line), Uncomplicated crown fracture - fracture of crown of tooth not involving the pulp, Complicated crown fracture - fracture of crown of tooth involving the pulp, BOP - bleeding on probing with light pressure with a blunt periodontal probe. Sherman et al8 evaluated the ability of clinicians to detect residual calculus following subgingival scaling and root planing. If closed SRP does not resolve signs of periodontal inflammation, the patient should be informed of the need for and availability of advanced therapy. The studies demonstrated a direct correlation between increasing probing depth and increasing percentage of root surfaces exhibiting residual calculus after treatment. Stage 4 (PD4) - AL > 50% or furcation 3 exposure. 18. The introduction of minimally invasive surgical techniques combined with high-resolution dental videoscopes, when used to treat periodontitis, resulted in the discovery of root surface features not previously reported, i.e., microgrooves [1,2] and microislands of the calculus [].The microislands are embedded in cementum and represent residual deposits of calculus following . Resorption of residual ridge is a complex biological phenomenon characterized by decreased amount and form of residual ridge after teeth are extracted. The need for meticulous self-care cant be overemphasized. Some powered scalers may also be fitted fiber-optic lighting for improved visual access during therapy. BMC Oral Health. sharing sensitive information, make sure youre on a federal The oral examination will include inspection and palpation of the extraoral structures, including the face, lips, and muscles of mastication; temporomandibular joints; salivary glands; lymph nodes; maxillae and mandibles; and looking for swelling, atrophy or asymmetry. Author P B Robertson. 3. 8600 Rockville Pike Although improved shielding of pacemakers may have negated much of this risk in recent years, it may still be prudent for practitioners to avoid use, or consult on use of magnetostrictive-type scalers in patients with pacemakers.16, Initial periodontal therapy, incorporating instrumentation and effective oral hygiene by the patient, is associated with expected decreases in bleeding and plaque levels, reduced probing depths, and improvement in periodontal attachment levels.4. Some of the key features of these instrument types are addressed in Table 1. Instruments are held in a set position against a mechanized sharpening wheel/blade, removing the need to calculate sharpening angles and speeding the process. Patients who have been diagnosed with periodontal disease (Stage I through Stage IV) and adequately treated should always be placed on a schedule aimed at maintaining periodontal health. Loe H, Theilade E, Jensen SB. Join our email list today and get a free pintable with the latest blood pressure ranges and categories to hang in your dental office! Severely advanced periodontitis. Harrel SK, Cobb CM, Sottosanti JS, Sheldon LN, Rethman MP. Useful inclusions: Chair-side developer with rapid developer/fixer, ideally radiographic viewing box. J Dent Res. Agreement between examiners in detecting calculus after instrumentation is low.22 More calculus tends to be left behind on proximal surfaces, in deep sites, and in furcation areas.21, Waerhaug23 evaluated the effectiveness of subgingival instrumentation on a sample of condemned teeth and concluded that the chances of removing all subgingival deposits are high in pockets smaller than 3 mm. 1990 Jan;61(1):16-20. doi: 10.1902/jop.1990.61.1.16. There is not clear consensus on a gold standard treatment regimen/instrument selection, and peri-implant disease is largely managed on a case-by-case basis. Bookshelf Research suggests that the amount of residual calculus and subgingival plaque is the same irrespective of whether a . Determine the level of gingival inflammation (GI); see above. Haffajee AD, Cugini MA, Dibart S, et al. A computer-processed algorithm determines whether the probe is in contact with dental calculus and activates both an auditory and light signal to notify the clinician of the presence of the calculus (Figures 4 and 5). The effectiveness of subgingival scaling and root planning. The extent of residual calculus was directly related to pocket depth, was greater following scaling only, and was greatest at the CEJ or in association with grooves, fossae or furcations. Analysis and interpretation of these studies is complicated by factors including differences in experimental design, treatment protocols, and methods of data collection. Scaling and root planing with and without periodontal flap surgery. M3 = Severe mobility > 1 mm or intruded into socket or can be extruded out of socket, 1 = Lesion in enamel, cementum The diameter of the DetecTar probe is the same (0.45 mm) as that of a conventional probe, allowing the clinician to perform the examination as usual. The pathogenesis of periodontal diseases. Clinical responses related to residual calculus. Nyman S, Westfelt E, Sarhed G, Karring T. Role of diseased root cementum in healing following treatment of periodontal disease. Federal government websites often end in .gov or .mil. There can be variable amounts of plaque and calculus present, although as a general rule, the more plaque and calculus covering the tooth surface, the more severe the disease. 4 = Significant coronal tooth loss As dental hygienists, we know that periodontal health cannot be maintained without the removal of both supragingival and subgingival calculus. It is not affected by thickness (thin veneers or large ledges), surface quality (burnished or uninstrumented), or various degrees of mineralization. In addition to armamentarium for polishing and instrument sharpening, a simple kit might include the following (or equivalent): --Diagnostics: Double-sided mirror; periodontal probe (UNC-12); calculus explorer (ODU 11/12); nabers furcation probe, --Supragingival scalers: Anterior sickle; universal, --Gracey curettes: Anterior mini (1/2); cuspid/bicuspid/flat-surface (5/6); distal surface posterior (13/14); mesial surface posterior (15/16), --Ultrasonic inserts: Standard insert; slimline straight; slimline left- and right-curved. Sites where calculus was detected at visit 1 were retreated. The effect of SRP on the clinical and microbiological parameters of periodontal diseases. sharing sensitive information, make sure youre on a federal 2012;91(10):914-920. The first peaks of the 11-A and 34- several calcium phosphates phases, mainly whitlockite and C biological samples, attributed to Zn-O, are centred at a greater R hydroxyapatite. Some of the indications for dental radiography include: 1. Generally, it appears that despite the presence of microscopic aggregates of residual root calculus, if clinically detectable calculus (with the DetecTar or the dental endoscope) is removed, gingival wound healing will occur. So-called disinfection of the root surface (removal of subgingival surface plaque but not subgingival calculus) is inadequate when subgingival calculus is present. I. Stage 1 (PD1) - Gingivitis - reversible, no attachment loss (AL*) The effectiveness of subgingival scaling and root planning. Tunkel J, Heinecke A, Flemmig TF. Read More. At probing depth > 5.0 mm, the chance of failure becomes dominant. Introduction. Dental Calculus / therapy* Dental Prophylaxis* Dental . The effects of age and oral hygiene of subjects in these studies were also not consistently addressed. 20. Handles may be resin covered for a more comfortable grip (eg, elliptically shaped cushion grips) and may be textured for improved rotational control. J Clin Periodontol. 2019 Nov 18;7(4):108. doi: 10.3390/dj7040108. A systematic review of the effect of surgical debridement vs nonsurgical debridement for the treatment of chronic periodontitis. Unauthorized use of these marks is strictly prohibited. Results after 30 years of maintenance. White DJ. 1965;36:177-187. 1978;49(3):119-134. and transmitted securely. It appeared that the calculus left behind following thorough instrumentation was difficult to detect clinically. Periodontal probing with a blunt-ended probe measures the depth of the gingival sulcus or pocket. A Clinical Study. Currently, the thoroughness of subgingival root debridement is determined by the degree of smoothness and hardness of the root surface. A systematic review of efficacy of machine-driven and manual subgingival debridement in the treatment of chronic periodontitis. Handles have progressed toward use of wider, lighter weight handles with a more ergonomic design. Before diagnosis and treatment decisions can be made, thorough evaluation of the periodontal tissues must be conducted. Egelberg J. Periodontics. 3 = Abundant soft plaque covering > 2/3 buccal tooth surface, F1 = Probe goes into furcation and up to 1/3 buccolingual crown width of multirooted tooth Heitz-Mayfield LJ, Trombelli L, Heitz F, et al. The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. reduction of residual calculus. Segelnick SL, Weinberg MA. Remove gross calculus to allow for periodontal probing. Note thin sheet of calculusbeneath also detected. 1 = Thin film along gingival margin covering < 1/3 of buccal tooth surface Mean probe penetration is greater with increased probing force and with increased gingival inflammation.3 Reproducibility of probing measurements varies among patients and with operator experience. 6. Nov 1996; 1(1):443-490. Would you like email updates of new search results? . M2 = Moderate mobility, > 0.5, less than 1 mm in any lateral direction Unfortunately, the removal of all calculus from the root surface can be very difficult if the teeth have more than a few millimeters of periodontal pocketing. 1984;11(1):63-76. J Periodontol. Reevaluation of initial therapy: when is the appropriate time? Clipboard, Search History, and several other advanced features are temporarily unavailable. Similar difficulties may occur during irradiation with a collimated light since laser tips can only be introduced in a gingival pocket parallel to the root direction. Save my name, email, and website in this browser for the next time I comment. This site needs JavaScript to work properly. The spectral signature of calculus remains constant for all subgingival calculus deposits. Stephen K. Harrel, DDS, is an adjunct professor in the Department of Periodontics at Texas A&M University College of Dentistry. Additionally, Sherman et al. DetecTar identifies subgingival calculus with an efficacy of ~91% in pockets of up to 10 mm depth, even in contaminated areas (blood, water, and plaque). Accept It is well established that plaque bacteria play a key etiologic role in development of gingivitis5 and in the pathogenesis of periodontitis.6 Subgingival plaque bacteria have been associated with periodontal disease progression, as measured by alveolar bone loss.7. Missing, rotated, and fractured teeth; probing depths (up to 6 points per tooth) of gingival recession; and hyperplasia . The teeth were extracted and evaluated for the presence and the percent surface area of calculus. Please check your email and click the confirmation button so we can send you your free blood pressure table! The site is secure. Root instrumentation until the surface feels hard and smooth upon probing is the current standard but this method relates only to surface texture, not to the adherent materials such as plaque and calculus. Clinical responses related to residual calculus. 2. Please enable it to take advantage of the complete set of features! However, assessment of nearly 30 years of comparative studies suggest no additive benefit to lasers.6 Advanced therapy may be performed by anyone who is adequately trained to legally perform such therapy. Dimensions is committed to the highest standards of professionalism, accuracy, and integrity in our mission of education supporting oral health professionals and those allied with the dental industry. While the American Academy of Periodontology and the European Federation of Periodontology published an improved classification of periodontal diseasesin 2018, the clinical application of the new classification as a guide to the delivery of care for patients in need of periodontal treatment is often unclear. Effect of nonsurgical periodontal therapy. Modifications to the forces applied with the probe (spring loaded, computer controlled pressure) were proposed to increase the accuracy of the probing. The periodontal probe is primarily used to measure pocket depth from the free gingival margin to the base of the periodontal sulcus or pocket (where the gingival epithelium attaches to the tooth surface).

Craven County Busted Paper, Replica Law Rocket Launcher, Roane County Mugshots 2021, Articles R