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      A Proposed New Index for Clinical Evaluation of Interproximal Soft Tissues: The Interdental Pressure Index

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          Abstract

          The interdental pressure index (IPI) is introduced to specifically evaluate clinical interproximal-tissue conditions and assess the effect of interproximal hygiene stimulation. This index scores clinical responses of periodontal tissues to the apical pressure of a horizontally placed periodontal probe. It is negative when gingival tissues are firm, bleeding-free, and slightly ischemic by the stimulation; otherwise it is positive. The clinical validation showed high intraoperator agreement (0.92; 95% CI: 0.82–0.96; P = 0.0001) and excellent interoperator agreement (0.76; 95% CI: 0.14–1.38; P = 0.02). High internal consistency with bleeding on probing ( κ = 0.88) and gingival index (Cronbach's α = 0.81) was obtained. Histological validation obtained high sensitivity (100%) and specificity (80%) for IPI+ toward inflammatory active form. The same results were recorded for IPI− toward chronic inactive form. IPI results as a simple and noninvasive method with low error probability and good reflection of histological condition that can be applied for oral hygiene motivation. Patient compliance to oral hygiene instructions is essential in periodontal therapy and IPI index can be a practical and intuitive tool to check and reinforce this important aspect.

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          Most cited references32

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          The oral hygiene index: a method for classifying oral hygiene status

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            Indices to measure gingival bleeding.

            E Newbrun (1996)
            Gingival bleeding is an objective, easily assessed sign of inflammation that is associated with several periodontal diseases. Many bleeding indices have been devised; some assess bleeding as simply present or absent, whereas others use grading in an attempt to assess severity of bleeding. The choice of which index to use depends on whether the purpose is an epidemiological survey, a clinical study, diagnosis and treatment, or patient motivation. Bleeding may be elicited manually with toothpicks, dental floss or a periodontal probe, but a controlled-force probe, although more expensive, causes less trauma and less false-positive bleeding from healthy tissues. As a predictor of periodontal disease progression, bleeding on probing has low sensitivity owing to a high frequency of false-positive responses, but has high specificity in that failure to bleed indicates health. There is evidence that smokers have less, or delayed, gingival bleeding when compared with non-smokers; therefore smoking needs to be controlled for in studies of gingival bleeding. Measurement of gingival bleeding tendency should be an integral part of a comprehensive oral examination. In clinical practice, the use of a graded bleeding index is more likely to identify sites that are at risk of further destructive activity. For monitoring individual patients, both for response to initial therapy and during maintenance, a modified Sulcus Bleeding Index (mSBI) with three bleeding scores is recommended in preference to dichotomous scoring of bleeding.
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              Molecular and cell biology of the gingiva.

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                Author and article information

                Journal
                Int J Dent
                Int J Dent
                IJD
                International Journal of Dentistry
                Hindawi Publishing Corporation
                1687-8728
                1687-8736
                2014
                1 April 2014
                : 2014
                : 345075
                Affiliations
                1Department of Periodontology & Implantology, DIBINEM, Alma Mater Studiorum-University of Bologna, Via San Vitale 59, 40100 Bologna, Italy
                2Section of Pathology, Department of Haematology and Oncological Sciences, Bellaria Hospital, University of Bologna, Via Altura 3, 40100 Bologna, Italy
                3Department of Medical Sciences, University of Trieste, Piazza dell'Ospitale 1, 34100 Trieste, Italy
                Author notes

                Academic Editor: Stefano Corbella

                Article
                10.1155/2014/345075
                3995173
                24799903
                8edeed40-9016-48ba-9dda-a963bc48f467
                Copyright © 2014 Checchi Luigi 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.

                History
                : 13 January 2014
                : 10 March 2014
                Categories
                Research Article

                Dentistry
                Dentistry

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