Signs of healthy periodontal tissue during visual examination of the gums. Gingival appearance.
Color: Remove saliva with an air syringe or gauze.
- Light pink.
- Dark pink. Melanin pigmentation.
- Incipient or acute inflammation results in a bright red color.
In chronic inflammation, the tissue often appears dark red or bluish-purple.
Contour (margin and papillae):
- The gingival margin is flat or slightly rounded.
- It conforms to the root surface.
- The gingival margin is located 3 mm from the amelocemental junction.
- Healthy interdental papillae are pointed, pyramidal, or slightly rounded.
When diastemas or open contact points are present, healthy papillae are flat.
Texture:
- Healthy free gingiva: smooth and shiny.
- Healthy attached gingiva: pitted or “orange peel” texture.
- Acute inflammation: loss of pitting.
Chronic inflammation: pitting appears normal.
Signs of a Healthy Periodontium on Clinical Examination and Probing
Gingival margin: Determine its position relative to the amelocemental line (ACL). Measure retraction or hypertrophy in millimeters.
Bleeding is the most reliable sign of inflammation. Bleeding on probing is quantified using various gingival indices.
Sulcus: Normal probing depth is 0.5 mm to 3 mm, measured manually or electronically.
- Six probing sites are assessed: 3 vestibular and 3 palatal or lingual.
- These measurements are recorded on the periodontogram (a graphical representation of the attachment and support periodontium).
Mobility: A clinical sign of loss of support. It is quantified in degrees of mobility (° 0–3).
- Class I: Mild, up to 1 mm. Vestibular-lingual displacement.
- Class II: Moderate, up to 2 mm. Vestibular-lingual displacement.
- Class III: Severe, greater than 2 mm. Intrusive-vertical displacement.
Furcal defects: Determine the loss of bone tissue between the roots (° 0–3).
- Class I furcation lesion: tissue destruction less than 2 mm.
- Class II furcation lesion: tissue destruction greater than 2 mm; the instrument cannot pass freely through the buccal or lingual/palatal roots. Non-permeable furcation.
- Class III furcation lesion: complete destruction allowing the instrument to pass freely through the buccal or lingual/palatal roots—the furcation is permeable.
Signs of a Healthy Periodontium on Radiographic Examination
- Alveolar bone crest at the level of the amelocementary junction or approximately 1 mm.
- Homogeneous consistency.
Types of Radiographic Examinations:
- Orthopantomogram.
- Periapical series.
Minimum of 12 X-rays. Covers all six quadrants.
Parallelism technique (positioner). Information: crown-to-root ratio, relationship between the crest and the amelocementary junction, width of the periodontal ligament, interproximal calculus, caries…
Does not provide information on the presence of pockets. Two-dimensional image. Radiography is a diagnostic adjunct.
