Gingival Changes Following after scaling, root planing, and oral hygiene in areas of advanced or severe gingival inflammation. The param­ eters studied were location of the mucogingival junc­ Scaling, Root Planing and tion, crevice depth, attachment level, height of the Oral Hygiene gingival margin, and width of the keratinized gingiva. A Biometric Evaluation* MATERIALS AND METHODS Fifteen patients at the University of Michigan School of Dentistry (6 females and 9 males) ranging in age by from 23 to 77 years (mean 44 ± 14.2) participated in the study. The experimental sample consisted of 61 THOMAS P. HUGHES, D.D.S., M.s.† teeth with labial or buccal inflammation extending well RAUL G. CAFFESSE, D.D.S., M.S., DR. into the attached gingiva, preferably to or beyond the mucogingival junction. Clinical measurements and ODONT.‡ scores were taken on these teeth during the three experimental sessions using the following indices and THE POSITIONAL CHANGES that may occur in the measurements. gingiva following scaling, root planing, and oral hy­ A. Inflammation Index giene (such as recession, reattachment, and variations in gingival width, pocket depth, and location of the The extent or degree of inflammation on the facial mucogingival junction) have not been studied system­ aspect of the tooth was clinically classified as: atically. However, it is generally assumed that some GV 1: Inflammation extending well into the attached gingival recession and/or some change in crevice or gingiva but not to the mucogingival junction. pocket depth may occur after scaling and root planing GV II: Inflammation extending to the mucogingival and that there is no change in the position of the junction. mucogingival junction. GV 111: Inflammation extending beyond the muco­ The location of the free gingival margin, the crevice gingival junction into the alveolar mucosa. depth, and the position of the mucogingival junction B. Dental Plaque Score can be determined accurately with the cementoenamel junction as a fixed reference point.1-5 Thus, it is The amount of dental plaque on the facial surface of possible to evaluate clinically any biometric changes in the tooth was evaluated using the Kobayashi-Ash the relationships between these structures before and Plaque Score22 based on the following criteria for after scaling, root planing and oral hygiene. classification: Recent reports indicate a tendency for the width of PI 0: Absence of dental plaque the attached gingiva to increase with age.6,7 Teeth in PI 1: Dental plaque on one of the interproximal labial version and teeth with adjacent muscle attach­ surfaces or on the middle of the facial gingival ment and/or frenum involvement of the attached gin­ margin aspect of the tooth and not covering giva, generally have a narrow zone of attached gingiva.8 more than one-third of the gingival one-half of With orthodontic hypereruption of teeth, the width of the facial surface. the attached gingiva may be increased with no change PI 2: Dental plaque on two interproximal surfaces, in the position of the mucogingival junction.9,10 Var­ or any two gingival margin surfaces but not ious mucogingival surgical procedures,11-21 may also covering more than one-third of the gingival increase the width of the attached gingiva, changing one-half of the facial surface of the crown of the position of the mucogingival junction. The effects the tooth. of other periodontal procedures on the width of at­ PI 3: Dental plaque extending from the mesial to tached gingiva and mucogingival junction are not distal and not covering more than one-third of known. the gingival one-half of the facial surface of the The purpose of the present study was to assess crown of a tooth. certain clinical changes that will occur in the gingiva PI 4: Dental plaque covering one-third to one-half of the gingival one-half of the facial surface of the crown of the tooth. * This study was submitted to the Horace H. Rackham School of PI 5: Dental plaque covering two-thirds or more of Graduate Studies, The University of Michigan, by the senior author the gingival one-half of the facial surface of the in partial fulfillment of the requirements for the degree of Master of Science in Periodontics. crown of the tooth. † Delray Beach, Florida. Formerly Department of Periodontics, Subjects were grouped as to whether there was (a) The University of Michigan School of Dentistry, Ann Arbor, Mich total plaque improvement (achieving a plaque score of 48109. ‡Professor, Department of Periodontics, The University of Mich­ 0 or 1); or (b) partial plaque improvement (plaque igan School of Dentistry, Ann Arbor, Mich 48109. score of 2 or greater) 245 J. Periodontol. 246 Hughes, Caffesse May, 1978 C. Clinical Measurements determination was performed only at the initial exper­ All clincal measurements were taken with a Marquis imental procedure. S-4 periodontal probe, calibrated in 3-mm segments Experimental Procedures which are color coded. Measurements were read at two locations on the facial aspect of the tooth: (1) at the The research project was composed of three experi­ midline of the tooth (for the molars, at the midline of mental sessions. (1) At the initial appointment prior to the mesial root); and (2) at the mesial interproximal scaling and root planing of the teeth, all clinical mea­ line angle. surements and scores were obtained and the subject The measurements recorded were (1) the distance received instruction in toothbrushing and dental floss­ from the cementoenamel junction to the gingival mar­ ing. The selected teeth then were scaled, root planed gin; (2) the crevice or pocket depth; and (3) the width and polished to remove all supragingival and subgingi­ of keratinized gingiva (including the free and attached val plaque, calculus and root surface roughness. (2) gingiva) from the gingival margin to the mucogingival One week after scaling and root planing the clinical junction (Fig. 1). measurements and scores were repeated. (3) After 1 To help locate the mucogingival junction when it was month they were recorded again. 23-24 not readily apparent, Schiller's IKI solution was Statistical Analysis used. All data obtained were analyzed statistically to deter­ D. Presence of Bone mine the significance of the results. Each of the five After the gingiva at the facial aspect of the tooth had parameters (location of the mucogingival junction, been infiltrated with local anesthetic, the presence of crevice depth, attachment level, height of the gingival alveolar bone underlying the mucogingival junction margin, and width of the keratinized gingiva) was was determined by penetrating the gingiva at this level tested statistically against the following variables: an­ with a sharp No. 3 explorer. If bone was felt, a "Yes" terior vs. posterior teeth, presence or absence of bone designation was recorded; if penetration extended to underlying the mucogingival junction, initial pocket the root surface, a "No" response was noted. This depth within the attached gingiva or extending to or beyond the mucogingival junction, total or partial plaque improvement, and classification of the initial inflammation. The parameters were tested against the variables separately for both the midline of the tooth and the mesial interproximal area. The statistical tests used were the Fisher's Exact Test and the Chi-Square Test for association in r x c contingency tables at the 5 % level of significance. Clinical Calibration Since all clinical scoring was performed by one examiner (T.P.H.), only the intraexaminer variation had to be determined. In order to assess the investiga­ tor's reproducibility, two randomly selected teeth on each of five human subjects with various degrees of periodontal disease were scored three times each, not consecutively, for inflammation, plaque and clinical measurements. Mean values for the inflammation score, the plaque score and the clinical measurements were computed and an analysis of variance between the three episodes of examination was performed. The results showed a very low scorer error and a high degree of reproducibility, at the 5% level of signifi­ cance . RESULTS Changes in the location of the mucogingival junction 1 month after scaling are represented on Table 1. No changes were significant at the 5% level of confidence. FIGURE 1. A diagram illustrating the clinical measurements. Table 2 shows changes in crevice depth 1 month after See text for explanation. scaling. A decrease in the cervice depth of 1 to 2 mm Volume 49 Number 5 Gingival Changes 247 TABLE 1. Changes in the Location of the Mucogingival Junction the changes in midline crevice depth in relation to the 1 Month after Scaling location of the bottom of the initial pocket. When the 1 mm 1 mm bottom of the initial midline pocket extended to or No change Coronally Apically beyond the mucogingival junction, there was a greater Midline 58 (95%) 2(3.3%) 1 (1.7%) tendency for a decrease in the crevice depth. Mesial 59 (96.7%) 2(3.3%) 0 Changes in the attachment level 1 month after scaling are indicated in Table 5. In approximately one-fifth of Total 117(95.9%) 4(3.3%) 1 (0.8%) the cases, 1 mm of new attachment was gained. The only variable tested in relation to the attachment level TABLE 2. Changes in the Crevice Depth 1 Month ajter Scaling to show statistical significance (P < 0.05) was initial mesial pocket depth (Table 6 and Graph 3). When the 1 mm 2 mm No change bottom of the interproximal pocket extended to or Decrease Decrease beyond the mucogingival junction, there was a greater Midline 36 (59%) 23 (37.7%) 2(3.3%) tendency for gain of clinical attachment. Mesial 30 (49.2%) 28 (45.9%) 3 (4.9%) Total 66 (54.1%) 51 (41.8%) 5(4.1%) TABLE 4.