Measurement of clinical attachment levels using a constant-force periodontal probe modified to detect the cemento-enamel junction

The handpiece of a Florida sleeve probe was modified to create a flange wit h the capability to detect the cemento-enamel junction (CEJ). This new inst rument (the Pressure-controlled, Automated, Standardised Handpicce or Flori da PASHA probe) was used to determine whether (a) the CEJ could be reproduc ibly detected in dried, human skulls and (b) clinical attachment levels cou ld be reliably measured in human subjects. When using the Florida PASHA pro be to detect the CEJ at 157 different sites in four dried, human skulls, th ere were no statistically significant (p greater than or equal to 0.15) dif ferences in mean CEJ detection measurements for any of the three participat ing examiners; either when the CEJ was visualised or obscured. The mean dif ferences between first and second replicates ranged from 0.00 to 0.08 mm. I ntraclass correlation coefficients (ICCs) of repeated measures in both cond itions ranged From 0.70 to 0.83 for tactile CEJ detection (CW obscured), an d from 0.95 to 0.96 for visual detection (CEJ visible). In human studies, t he Florida PASHA probe was used by two examiners to determine clinical atta chment levels (CAL) at 660 sites in 5 human subjects undergoing supportive periodontal therapy. Intra-examiner agreement of replicate measurements rec orded by the probe, as measured by calculating ICCs, ranged from 0.79 to 0. 85 for the 2 examiners, respectively. A statistically significant inter-exa miner difference in mean CAL measurements when using the Florida PASHA prob e was found (p<0.001). Notwithstanding this difference, inter-examiner agre ement was good, with an ICC of 0.83. These data suggest that the Florida PA SHA probe can reproducibly detect the CEJ and is proposed as a tool for mea suring CAL in humans.