Journal of Oral Biology
Research Article
Reproducibility of Manual Periodontal Probing Following a Comprehensive Standardization and Calibration Training Program
Bryan P. Fitzgerald1†, Charles E. Hawley1,2, Charles Q. Harrold3, J. Steven Garrett4, Alan M. Polson5 and Thomas E. Rams6
1Formerly Division of Periodontics, University of Maryland School
of Dentistry, Baltimore, Maryland, USA
2Department of Periodontology, Tufts University School of Dental
Medicine, Boston, Massachusetts, USA
3Formerly Department of Surgical Sciences, University of Colorado
School of Dental Medicine, Aurora, Colorado; presently retired,
Chandler, Arizona, USA
4Formerly Atrix Laboratories, Inc., Ft. Collins, Colorado, USA;
presently retired, Rigby, Idaho, USA
5Department of Periodontics, University of Pennsylvania School of
Dental Medicine, Philadelphia, Pennsylvania, USA
6Department of Periodontology and Oral Implantology, Temple
University School of Dentistry, Philadelphia, Pennsylvania, USA
†Deceased on November 20, 2018
*Address for Correspondence: Thomas E. Rams, Department of
Periodontology and Oral Implantology, Temple University School of Dentistry,
Philadelphia, Pennsylvania, USA; phone: (215) 707-2941/ fax: (215) 707-4223;
E-mail: trams@temple.edu
Submission: 12-May-2022
Accepted: 27-June-2022
Published: 29-June-2022
Copyright: © 2022 Fitzgerald BP, et al. This is an open access article
distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Abstract
Background: Clinical standardization and calibration training is
recommended to increase the reproducibility of periodontal probing, but
its impact on manual periodontal probing outcomes has received little
attention. This study examined the reproducibility of manual periodontal
probing performed by a periodontist after completion of a comprehensive
standardization and calibration training program.
Methods: A newly-educated periodontist was subjected to an
individualized periodontal probing standardization and calibration training
program involving approximately 24 total hours of lecture, bench-top, and
clinical instruction/evaluation. Satisfactory completion of each portion of
the training program required ≥ 95% intra-examiner agreement within
1 mm between initial and repeat measurements, and a ≥ 90% level of
exact agreement with measurements by a “gold standard” examiner. The
periodontist then evaluated bleeding on probing (BOP) and performed
duplicate measurements of probing depth (PD) and the distance between
the cementoenamel junction and gingival margin (CEJ-GM) with a manual
periodontal probe on 567 periodontal sites exhibiting ≥ 5 mm PD with BOP in
39 adults. Clinical periodontal attachment level (CAL) was calculated for each
site as (PD) - (CEJ-GM).
Results: Intra-examiner measurement error (the standard deviation for
a single measurement) was found to be 0.21 mm for PD, 0.15 mm for CEJGM,
and 0.26 mm for CAL. Replicate assessments of PD and CAL yielded
excellent exact agreement kappa scores of 0.86 and 0.87, respectively.
Greater intra-examiner measurement error was found at periodontal sites
with more gingival inflammation as measured by higher BOP index scores.
Conclusion: These findings demonstrate that a rigorous periodontal
probing standardization and calibration training program facilitates acquisition
of highly reproducible PD and CAL assessments in moderate to deep
inflamed periodontal pockets with a manual periodontal probe. Similar formal
hands-on training should be incorporated into dental education programs and
clinical research studies to improve the diagnostic performance of manual
periodontal probing of the periodontium.