To treat or not treat a sulcus based on
I get this question a lot when talking with people about
treatment planning periodontal issues. Probing depths
are used as a guide to tell us the extent of a pocket
and its relationship to its surrounding landmarks. We
can extrapolate that it relates to bone loss and it does
on some cases. The problem is relying only on the
number and not confirming it with other findings.
One of the most overlooked
indicators is tissue color and texture around an area of
concern, as well as how it compares with the rest of the
mouth. If the tissues are pink and firm throughout the
majority of the mouth and yet one area appears deep red
or bluish-purple, then it is an isolated issue, not to
Bleeding on probing is
another indicator we know but forget to use. Of
course, with a heavy hand any area can
bleed. "Slight provocation" is the phrase used when
checking for bleeding on probing. When light probing
elicits a bleeding response it means the capillary
system within the sulcus is inflamed and has increased
in response to a local infiltration. If you have to
push to make something bleed, then a wound has been
created and it is not a true problem area.
In Figures 3 and 4, the
distal of #30 has a 5 mm probing depth. The tissues
are pink and firm with no bleeding. The dentist
treated the area with scaling and root planing and
multiple rounds of Arestin. The patient’s home care is
immaculate and she has done well taking care of it.
is no matter how much scaling or antimicrobials placed
in the pocket, the “number” or probing depth will never
Look closer at the
radiograph. It shows a discrepancy of the crown margin
height. The distal of #30 crown is about 2 mm more
subgingival than the mesial of #31. This height
difference shows up in the pocket measurement.
Remember there has to be a biologic width associated
with restorative dentistry. If the 3 to 4 mm of
biologic width is not present, the body will make it
that way with an uncontrolled inflammatory process.
In this case, the pocket is
stable. Do not forget about it, watch it closely.
Because of the deeper restorative margin it has the
potential to become pathogenic and develop recurrent
decay. If this pocket begins to break down and bleed,
then crown lengthening should be performed to
reestablish appropriate biological width.