How to use the online periodontal chart

The following data can be entered to create an online periodontal chart: tooth mobility, furcation involvement, gingival margin (mm), probing depth (mm) and notes. The blue shaded area representing periodontal pockets will be created automatically when the red line which represents the gingival margin and the blue line which represents the attachment level (bottom of the periodontal pocket) are defined.

The degree of the furcation is charted using a circle. An open circle (degree 1), a semicircle (degree 2) and a filled in circle (degree 3).

Manual for the digital recording of the online periodontal charting tool

Clicking the number of any tooth will visually cross out the tooth as well as fade out all its values. Hold down SHIFT and click the number to reset all values of the tooth.

Clicking the implant button will replace the tooth symbol with an implant symbol.

Bleeding on Probing (BOP) and Plaque will be recorded on six sites per tooth (three buccal and three oral sites, respectively).

After entering the vaues hit the TAB key to move the cursor to the next field automatically.

Repeated clicking the furcation button will allow to set the degree of any furcation:
1 click: degree 1
2 clicks: degree 2
3 clicks: degree 3
4 clicks: reset

Clicking the note field will allow to enter a short note for each tooth.

Note:

Recording both Plaque and Bleeding on Probing can be simplified:

By clicking on the label for "PLAQUE" or "BLEEDING ON PROBING" the entire line will be marked. By SHIFT-clicking the same labels, the respective lines will be reset.

By holding down the SHIFT-key, the tabs can be activated by simply hovering with the mouse arrow (not by clicking).


How to save the online periodontal chart

The data entered into the online periodontal chart can be downloaded as a file directly into the browser's downloads folder.

The online periodontal chart can also be saved as a PDF file. Clicking on the 'Print' button opens the print dialogue where Adobe PDF can be selected. Clicking OK allows the user to select a file name and location for the PDF file.

Print

In the printing menu chose "Save as PDF".

Online periodontal charting tool print preview

Note:

Paper size will need to be set to A4. If necessary (e.g. in Apple Safari), the content can be scaled down below 100%.

Download

The following chart is available for manual charting and transfer at a later date if the clinical data cannot be simultaneously recorded electronically.

Periodontal chart scoring sheet

Download: Periodontal Chart Scoring Sheet

RO_Periodontal_Chart_Scoring_Sheet.pdf PDF

RO_Periodontal_Chart_Scoring_Sheet.xlsx Excel

EN_Periodontal_Chart_Scoring_Sheet.pdf PDF

EN_Periodontal_Chart_Scoring_Sheet.xlsx Excel

Calibration of clinical periodontal charting

The goal of clinical periodontal charting is to record gingival recessions, probing depths, and attachments levels at six sites per tooth or implant in mm. For all the measurements it appears to be reasonable to round up all the readings measured with the periodontal probe.

1. Gingival margin, probing depth, and attachment level

At every site, the value for "Gingival Margin" will be determined first followed by the measurement of the periodontal "Probing Depth". The value of "Attachment Level" will be calculated by the online pariodontal charting tool and displayed with a blue line in the diagram.

The "Gingival Margin" as the first value is the distance from the clinical gingival margin to any given reference such as, in most cases, the cemento-enamel junction. Crown margins and the margins of restoration should be chosen as a reference provided they are at least 3mm apical to the cemento-enamel junction (CEJ), otherwise, a virtual reference line should be chosen at the location of the original cemento-enamel junction.

The "Probing Depth" as the second value is the distance between the gingival margin and the bottom of the gingival sulcus or the periodontal pocket, respectively.

The "Attachment Level" for each site will be calculated based on the following formula:

Probing Depth (mm) – Gingival Margin (mm) = Attachment Level (mm)

Healthy periodontium

In a healthy periodontium, the cemento-enamel junction is located below the gingival margin and immediately above the attachment level. There is no attachment loss at sites with a healthy periodontium.

In this case, both values for gingival margin 1 and probing depth 2 are identical.

Probing healthy periodontium

In the figure above, the attachment level can be calculated based on the following formula:

Attachment Level 0mm = Probing Depth 2mm – Gingival Margin 2mm

Healthy periimplant tissues

At healthy periimplant sites, the margin of the suprastructure is located somewhat below the margin of the periimplant mucosa. There is no alveolar bone loss at healthy periimplant sites.

Probing healthy implant

In the figure above, the alveolar bone (attachment) level can be calculated based on the following formula:

Alveolar Bone (Attachment) Level 2mm = Probing Depth 3mm – Mucosal Margin 1mm

Gingival hyperplasia (overgrowth)

In some cases, the cemento-enamel junction may be located far below the gingival margin, however still immediately above the attachment level. This occurs in cases of gingival overgrowth or gingival hyperplasia.

In this case, again, both values for gingival margin 1 and probing depth 2 are identical.

Probing gingival overgrowth

In the figure above, the attachment level can be calculated based on the following formula:

Attachment Level 0mm = Probing depth 5mm – Gingival Margin 5mm

Note: Pseudo pockets are pockets of 4mm and more without attachment loss.

Healthy periimplant tissues in the esthetic zone

At healthy periimplant sites in the esthetic zone, the margin of the suprastructure is located further below the margin of the periimplant mucosa. There is no alveolar bone loss at healthy periimplant sites in the esthetic zone.

Probing deep healthy implant

In the figure above, the alveolar bone (attachment) level can be calculated based on the following formula:

Alveolar Bone (Attachment) Level 2mm = Probing Depth 5mm – Mucosal Margin 3mm

Periodontal pocket

At some diseased sites, the cemento-enamel junction may be located somewhat below or above the gingival margin. The distance between the gingival margin and the bottom of the periodontal pocket is then recorded as the periodontal probing depth 2.

Probing periodontal pocket

In the figure above, the attachment level can be calculated based on the following formula:

Attachment Level 5mm = Probing Depth 7mm – Gingival Margin 2mm

Note: Periodontal pockets of > 4mm following active periodontal thrapy are so called, residual pockets.

Periimplant pocket

At sites with periimplantitis, the margin of the suprastructure may be located somewhat below or above the margin of the periimplant mucosa. The distance between the mucosal margin and the bottom of the periimplant pocket is then recorded as the periimplant probing depth 2.

Probing periimplantitis

In the figure above, the alveolar bone (attachment) level can be calculated based on the following formula:

Alveolar Bone (Attachment) Level 6mm = Probing Depth 7mm – Mucosal Margin 1mm

Gingival recession

Gingival recession is the condition seen when the gingival margin is located apically to the cemento-enamel junction. The value noted as the gingival margin 1 should be recorded as a negative value.

Probing gingival recession

In the figure above, the attachment level can be calculated based on the following formula:

Attachment Level 6mm = Probing Depth 2mm – Gingival Margin -4mm

Periimplant recession

Periimplant recession is the condition seen when the mucosal margin is located apically to the margin of the suprastructure. The value noted as the mucosal margin 1 should be recorded as a negative value.

Probing periimplant recession

In the figure above, the alveolar bone (attachment) level can be calculated based on the following formula:

Alveolar Bone (Attachment) Level 4mm = Probing Depth 2mm – Mucosal Margin -2mm

Six sites per tooth or implant

The selection of the six sites per tooth or implant for the measurement of both periodontal pockets and attachment levels is critical. Each tooth or implant is divided into six sections when observed from the occlusal aspect. The site with the deepest periodontal or periimplant probing depth should be recorded for each section.

Probing six sites per tooth

Angulation of the periodontal probe

The periodontal probe is inserted along the root surface of the tooth in order to measure the periodontal probing depths. The instrument should be angulated in a mesio-distal direction A or B, respectively while keeping it parallel to the long axis of the tooth (avoid angulations in a buccal-lingual direction).

Angulation of the periodontal probe

2. Severity of furcation involvement

Furcations of all molars and first premolars of the upper jaw should be assessed with a furcation probe. The horizontal component of probing is graded (0 - 3) according to the following criteria (Hamp et al., 1975):

Probing furcation

Grade 0 = Furcation not detectable

Grade 1 = Furcation detectable, with a horizontal component of probing ≤3mm

Grade 2 = Furcation detectable, with a horizontal component of probing >3mm

Grade 3 = Furcation is opened through and through

3. Tooth mobility

Tooth mobility should be determined using two single-ended instruments and assessed according to the following criteria (Miller, 1950):

Grade 0 = Normal (physiologic) tooth mobility

Grade 1 = detectable mobility (up to 1mm horizontally)

Grade 2 = detectable mobility (more than 1mm horizontally)

Grade 3 = detectable vertical tooth mobility

Literature

Miller S. C., Textbook of Periodontia, 3rd edition, The Blakiston Co., Philadelphia and Toronto,1950.

Hamp S. E., Nyman S., Lindhe J., Periodontal treatment of multirooted teeth. Results after 5 years. J. Clin. Periodontol. 1975;2:126–135. doi: 10.1111/j.1600-051X.1975.tb01734.x.