Additional Diagnosis—Tests

• Microbiologic Tests

• Tests of Host Response

The classical clinical examination methods were presented in the previous pages (pp. 168–175). New tests have become available in recent years, which should permit improved diagnosis and therefore also improved prognosis.

Figure 405 (modified from Lindhe et al. 1997) presents a summary of all these tests; those marked with a solid bullet are presented in detail in the following pages.

The use of these diagnostic test methods is often time-consuming and expensive, and therefore not indicated or not necessary for uncomplicated chronic periodontitis cases. Such tests can only be recommended for establishing the prognosis in difficult-to-classify individual cases.

Tests for Microorganisms

The primary periodontopathic microorganisms can be identified using various methods (see Fig. 405).

Tests of the Host Response

The composition of the bacterial pocket flora is important, but of equal importance is the general host response to the infection (see Etiology, p. 39), including the markers and mediators in peripheral blood, in sulcus fluid, as well as genetic, non-alterable risk factors, e.g., gene polymorphisms. The pathogenic bacteria and the host’s reaction to them or to their metabolites elicit further cellular reactions and lead to destructive processes in the periodontal tissues. This includes above all clinical attachment loss and resorption of alveolar bone.