Absence of bleeding on probing Niklaus P.

Lang, Rolf Adier,

Andreas Joss and Sture Nyman
University of Berne, School of Dental
Medicine, Berne, Switzerland
An indicator of periodontal stability .

Lang NP, Adler R, Joss A and Nyman S. Absence of bleeding on probing - An

indicator of periodontal stability. J Clin Periodontol 1990; 17: 714-721.

Abstract. Following active periodontal therapy, 41 patients were incorporated

in a maintenance program for 2 1/2 years with recall intervals varying between
2-6 months. At the beginning of each maintenance visit, the periodontal tissues
were evaluated using "bleeding on probing" (BOP). Reinstrumentation was only
performed at sites which bled on probing. However, supragingival plaque and
calculus was always removed. Pocket probing depths and probing attachment
levels were recorded after active treatment and at the conclusion of the study.
Progression of periodontal disease was defined by an observed loss of probing
attachment of > 2 mm. The reliability of the BOP test as a predictor was evaluated
by calculating sensitivity, specificity, accuracy, and positive and negative predic-
tive values. While only a 29% sensitivity was calculated for frequent bleeding, the
specificity was 88%. The fact that the positive predictive value for disease pro- Key words: periodontal health; bleeding on
gression was only 6% and the negative predictive value was 98% renders probing; diagnosis; loss of probing attach-
ment; maintenance care.
continuous absence of BOP a reliable predictor for the maintenance of perio-
dontal health. Accepted for pubiication 2 November 1989

In recent years, much interest has been
focused on the evaluation of existing
routinely used periodontal diagnostic
parameters for their accuracy to be used
as predictors for progression of perio-
dontal disease or disease recurrence fol-
lowing periodontal therapy. In this con-
text, the predictive value of bleeding on
probing (BOP) has been tested in a few
clinical studies (e.g., Badersten et al.
1985, Lang et al. 1986). The results of
these studies revealed that BOP yielded
rather low predictive values for disease
progression and/or recurrence. One of
the reasons for this finding, however,
could have been that the studies were
carried out in patients enrolled in a
maintenance care program following
treatment, and repeated instrumen-
tations of all sites exhibiting bleeding
on probing were performed for ethical
reasons. These repeated interferences
with the subgingival microbiota may
have contributed to an improvement of
the periodontal conditions, thereby ob-
scuring the predictive value of BOP for
disease progression. Ideally, the predic-
tive value of BOP for disease pro-
gression should be determined in a sys-
tem without the interference of regular
maintenance care. Since such a study
cannot be done for ethical reasons, it
appears logical to study the importance
of absence of BOP for the maintenance
of periodontal health rather than the sig- healing period of 1 month, reevaluation
nificance of presence of BOP for the was carried out and periodontal surgery
recurrence or progression of disease. using the modified Widman flap pro-
The purpose of this prospective clin- cedure (Ramfjord & Nissle 1974) was
ical trial was to determine the predictive performed in areas where pocket prob-
value of absence of "bleeding and prob- ing depths of 5 mm or more remained
ing" for the maintenance of periodontal (less than 50% of the patients). At least
health and to test the feasibility of such 1 month (up to 3 years) following the
a clinical parameter in a private practice surgical procedure, the patients were re-
situation. evaluated and baseline data for this
study obtained. The baseline data for
the patients who did not need surgical
Material and Methods therapy were obtained at various time
50 patients were selected for this clinical points following the completion of the
trial on the basis of the presence of hygienic phase but during ongoing
periodontal disease and the patients maintenance. None of the patients were
availability for maintenance visits fol- aware of their participation in the clin-
lowing active periodontal therapy. At ical trial.
the completion of the study, 14 males Maintenance visits were scheduled at
and 27 females, 20 to 60 years of age, regular intervals varying between 2 and
were available for final evaluation be- 6 months. Hence, within the designed
cause of their compliance with the main- observation period of the present study
tenance schedule, while 9 patients had 2-2'/2 years), the patients had presented
to be excluded from evaluation because for maintenance therapy at least 5 times
of irregularities (Fig. 1). Initially, all pa- (Table 1).
tients presented with moderate to ad-
vanced periodontal disease with at least
one advanced lesion (i.e., pocket prob- Ciinicai procedures
ing depth > 6 mm and loss of alveolar All maintenance care was performed by
bone >40% of the root length) in each the same experienced dental hygenist
quadrant. Initial treatment comprised and supervised by the same general den-
motivation and instruction in oral hy- tist with special post graduate training
giene measures and scaling and root in periodontics (RA). At the beginning
planing of all tooth surfaces. After a of each maintenance visit, the con-
 Absence of bleeding 715

Table 1. Distribution of patients according to value was calculated as the percentage

and probing attachment levels were re-
recall frequency within 2 years and up to 30 of bleeding gingival units out of the
corded by the same examiner (R.A.)
months total number of sites examined per indi-
who had been calibrated for reproduci-
vidual. Reinstrumentation was per-
bility prior to the study. These par-
No. formed only in those sites where "bleed-
ameters were recorded after the assess-
maintenance visits patients ing on probing" occurred. Sites where
ment of gingival bleeding, but before
5 9 no bleeding occurred were not reinstru-
scaling and root planing of bleeding
20 mented. Supragingival plaque and cal-
sites. The sanae type of graduated
- . 7 .'. ., ^ ; , . f ' ' culus were always removed. At the end
Michigan Ml periodontal probe with a
.- . - . . . t : 1 ^ of each maintenance visit, all teeth were
point diameter of 0.4 mm was used for
9 2 polished with rubber cups and an abras-
assessing bleeding and for measuring
ive paste (Nupro prophylaxis paste /
pocket probing depth. Probing depths
Johnson & Johnson). In addition, the
and clinical attachment levels were as-
ditions of the periodontal tissues were teeth were fluoridated topically with
sessed to the nearest millimeter. The
evaluated by assessing "bleeding on Duraphat varnish. margins of dental restorations were
probing" (BOP) to the bottom of the used as reference
Based on individual needs, reinstruc- points for the attach-
clinical pocket or sulcus using a perio- ment level measurements, when the ce-
tions in oral hygiene measures were
dontal probe (Michigan Ml). If bleed- mento-enamel junction was obstructed
given a variable number of times for
ing occured within 10-15 s, a positive by restorations or was difficult to ident-
the entire duration of the study. Oral
score was given. Similar to the method ify. Furcation involvements were re-
hygiene instruction comprised the Bass
of Ainamo & Bay (1975) an individual corded and classified as partially or
(1954) tooth brushing method and inter-
BOP-index of the dichotomous scores completely open, depending on the
dental cleansing with floss, toothpicks
was calculated. Interproximal sites were depth of penetration of a calibrated
or interdental tooth brushes.
scored both from the buccal and the curved probe.
Clinical parameters The most important parameter ana-
lingual sides of the contact area. Either
side could contribute to a positive score At baseline and at end of the obser- lyzed ia the present study was BOP.
for the interproximal region. The BOP vation period, pocket probing depths Owing to the fact that the patients had
been exposed to different numbers of
maintenance appointments, ranging in-
dividually from 5 to 9 times with the
20 -1 majority of patients having been evalu-
17 ated 6 times within the observation
period, the frequencies of BOP were
15
normalized to 6 for all patients accord-
ing to Table 2. .: : / .
CO

10 - Data analysis
(D
For the purpose of simplicity, only data
E based on normalized BOP-frequencies
3 are presented in this report.
Sites in which complicating factors,
such as furcation involvements, restora-
tions or adjacent extractions performed
20-29 30-39 40-49 50-59
during the maintenance phase, could in-
Age (baseline) fluence gingival bleeding were excluded
Eig. 1. Age and sex distribution and number of patients at basehne prior to the maintenance from analysis. Also, all sites of third
program. molars were disregarded. Of these rea-
sons 369 sites (9%) were excluded, and
a total of 3807 (91 %) sites in 41 patients
Table 2. Actually scored BOP frequencies were available for statistical analysis.
Normalized frequency of BOP Separate calculations of interproxi-
Actual number of mal sites (i.e., exclusion of buccal and
maintenance visits 0 1 2 3 4 6
lingual sites) in order to avoid the influ-
5 0 1 2 _ 3 4 5 ence of possible trauma from tooth
6 0 1 2 3 4 5 6 brushing were also performed. Because
7 0 1 2 3/4 5 6 7 of anatomical differences in different in-
0 2/3 4 5/6 8 terproximal areas, premolar and molar
9 0 1 2/3 4/5 6/7 8 9 interproximal sites (side teeth) were also
group rarely occasionally frequently analyzed separately.
Progression of periodontal disease
Example (circled in Table 2). A patient who was seen at 8 maintenance visit: a site having a
normalized BOP frequency of 5 (out of 6) actually scored 7 out of 8, and a site having a
was defined by scoring both > 1 mm
normalized BOP frequency of 1 (out of 6) actually scored 1 out of 8. and > 2 mm ofprobing attachment loss
716 Lang et al.

Disease : selection of the "standards" number of the patients exhibited satis-

factory standards of oral hygiene. How-
Present,if Absent, if
Diagnostic LOA < 2mm
ever, about 50% of the patients needed
LOA > 2nnm
test continous reinforcement in oral hygiene
measures. As a result of the variation
Positive, if BOP- a b in individual oral hygiene standards, a
Positive Predictive Vaiue
incidence = 5 or 6 True Positive False Positive = a / (a+b) wide range in individual mean BOP-
values (7-60%) was noted. If consider-
ing an avarage individual mean BOP-
Negative, if BOP- C d Negative Predictive Value value of 25% as the highest acceptable
incidence = 0 to 4 False Negative True Negative = d / (c+d) value for adequately maintained gin-
gival conditions (Lang et al. 1986), 19
patients (6 males and 13 females) (46%)
complied with this goal (Fig. 3).
Prevaience = (a+c) / (a+b+c+d)
In 58% (2213) of all sites, bleeding
Sensitivity Specificity on probing was rarely observed (BOP
= a / (a+c) = d / (b+d) Accuracy = (a+d) / (a+b+c+d)
prevalence ^=0 or 1), in 30% (1138) oc-
Fig. 2. Diagnostic test characteristics and definitions. Example for "disease progression" if casional bleeding (BOP prevalence = 2,3
LOA > 2 mm; diagnostic test is positive if BOP - frequency >5 (5 or 6). or 4) and in 12% {456} frequent bleeding
(BOP prevalence = 5 or 6) was noted
(Fig. 4).
Out of the 3807 sites analyzed in
respectively between the baseline and In essence. Fig. 2, in which a loss of the present study, 17.3% yielded an in-
the final examination, although it is attachment of > 2 mm as a standard for crease in measured loss of attachment
understood that 1 mm of probing disease progression as well as a BOP (LOA) of > 1 mm and only 2.4% a
attachment loss may lie within the meas- frequency of > 5 as a threshold for a LOA of > 2 mm. In the analysis these
urement error for periodontal probing positive diagnostic test was depicted as two values will be used as "standards"
(Fowler et al. 1982). Hence, these an example, represents the definitions for the assumed disease progression
attachment level changes were con- used in the present report. The diagnos- during the maintenance period. Figs. 5
sidered as "standards" for the vali- tic sensitivity and specificity represent and 6 describe the probing depths
dation of the clinical test of "bleeding retrospective ratios, while negative and (PD) and attachment levels (AL) at
on probing" as a predictor for the pro- positive predictive values address the the end of the maintenance period in
gression of periodontal disease or the future probabilities for maintenance of relation to the prevalence of BOP. It
maintenance of health. The relability of health or for disease progression. is evident that with increasing probing
the BOP test was evaluated by calculat- depth, increasing BOP prevalences
ing the sensitivity, specificity, accuracy, were noted. Very few pockets with a
prevalence, positive and negative pre- probing depth of 6 to 9 mm did not
dictive values in relation to the stan- Results
bleed on probing at any observation
dards described (Fletcher et al. 1982) The present study reports on 41 patients time. Increasing BOP prevalences were
(Fig. 2). These criteria were calculated which had been treated for periodontal also noted with more apical AL. The
separately for BOP-frequencies of > 2 disease and were incorporated into a most frequently encountered sites
and > 5 as a positive diagnostic test maintenance program including recall which rarely bled on probing were in
representing occasional or frequent visits at intervals of 3 to 5 months for the PD range of 1 to 3 mm and/or at
bleeding on probing. a period of 2-2.5 years. About half the sites with no loss of attachment.
Only 2.1% (81) of the sites showed
a gingival recession of > 2 mm, while
12 -1 97.3% (3702) showed no change in the
position ofthe gingival margin ( + /1
mm) (fig. 7). In the remaining 0.6% (24)
(0 of the sites a coronal displacement of
-
c the gingival margin of > 2 mm was
o
CO noted. Higher prevalences of BOP were
Q. observed in these sites when compared
with stable or recession sites.
O The differences in probing depth be-
X! tween the beginning and the termin-
E ation of maintenance phase in relation
3 to the BOP prevalences are depicted in
Fig. 8. An increase in probing depth to
>2 mm was found in 31 (0.8%) of all
7-12 13-19 20-25 26-31 32-42 43-60 sites. These 31 sites yielded significantly
Fig. 3. Mean BOP - values over the observation time (2.5 years), calculated as patient avarage higher prevalences for BOP when com-
ofthe individual mean BOP at each recall visit. pared to the 98.1% (3735) of the sites
 Absence of bleeding 717

2000 n with no change in PD (-|-/-1 mm) or

the 41 (1.1%) sites with reduced PD.
This latter category of sites clearly
CO showed the lowest prevalence of BOP.
There were no sites which bled fre-
CO
M- 1000 -
quently (BOP prevalence=5 or 6) in the
group of pockets exhibiting reduction
o
In Fig. 9, the sites with loss (2.4%,
3
91) or gain (.17%, 64) of clinical attach-
tnent of > 2 mm and those with a stable
attachment level are presented. The
1 prevalence for BOP was greatest in the
Rarely Occasionally Frequently sites which exhibited attachment loss
fig. 4. Incidence of sites exhibiting BOP (6 recalls). during the maintenance period. In this
category, 28% of the sites bled fre-
quently on probing (BOP prevalence =
5 or 6), while 32% bled rarely (BOP
prevalence=0 or 1).
If an LOA of > 2 tnm is chosen as a
"standard" for defining disease pro-
100 gression (Fig. 10), only about 6% of
the sites with frequent bleeding (BOP
frequency=5 or 6) showed progression
irrespective of the locahzation of the
sites. On the other hand, only about
1.3% of the sites exhibited progression,
when bleeding was raraly encountered,
D Oof 6
A much higher proportion of the sites
1 of 6
2 of 6 (16.5-19.7% for all teeth) yielded dis-
3 of 6
ease progression if an LOA of > 1 mm
was chosen as a "standard" (Fig. 11),
4 of 6
With this standard, only ititerproximal
5 of 6
sites of molar and premolar teeth (m-hd
6 of 6
side teeth) showed increasing pro-
gression of disease with increasing
Total 1-3 4/5 6 - 9 mm bleeding prevalence.
3807 3268 493 46 Sites Table 3 summarizes the percentages
Fig. 5. Final probing depths in relation to BOP prevalence. for the parameters mentioned and de-
fined in Fig. 2. Depending on the "stan-
dard" chosen for the definition of dis-
ease progression, the prevalence of pro-
gressing sites was 17.3% (LOA > 1 mm)
or 2.4% (LOA > 2 mm). While the
specificity of the BOP-test was hardly
affected by the choice of the "standard",
100
it was dependent on the threshold level
for a positive test. A BOP-frequency of
> 5 resulted in 88.4% specificity and a
BOP-frequency of > 2 showed a lower
specificity of 58.7%. On the other hand,
the sensitivity of the BOP-test was af-
D Oof 6
fected by both the choice of the "stan-
1 of 6
dard" for disease progression and
2 of 6
threshold level for a positive BOP-test.
3 of 6
The highest sensitivity of 66.7% was
4 of 6
found if a "standard" for disease pro-
5 of 6
gression of LOA > 2 mm and a thresh-
6 of 6
old level for a positive BOP-test of > 2
was chosen. The predictive values were
Total 0 1-2 3-4 5-6 7-8 mm dependent on the choice of the "stan-
3807 347 1463 1323 549 125 Sites dard" for disease progression rather
Fig. 6. Final attachment levels in relation to BOP prevalence. that on the threshold level for a positive
718 Lang et al.

100 BOP-test. The positive predictive value

was low (3.8-5.8%), if a LOA of >2
mm was chosen as the "standard" for
disease progression and still moderate
(17.9-20.0%) if a LOA of > 1 mm was
BOP - Prevaience
chosen. However, the negative predictive
"35 Oof 6
1 of 6
values for disease progression obtained
o by the BOP-test was high (83.1%) with
2 of 6 the "standard" of > 1 mm and reached
3 of 6 almost 100% (98.1-98.6%), if a LOA
4 of 6 of > 2 mm were chosen as the "stan-
5 of 6
dard" for disease progression.
6 of 6

Total Coronal Stable Recession

:; , 3807 24 3702 81 Sites Discussion
Fig. 7. Difference in position of the gingival margin of > 2 mm during the observation time
in relation to BOP prevalence. In the present study, 27% ofthe patients
(11) demonstrated mean BOP-values of
less than 20% of all sites for all the
recall visits during the observation
period. 44% (18) yielded mean BOP
percentages between 20 and 31% and
29% of the patients (12) mean BOP

H -
uu - " "
values exceeding 31% (Fig. 3). When
analyzing single sites, 58% of the sites
80 - bled rarely and 12% yielded frequent
bleeding (Fig. 4). These percentages are

H
slightly higher than those encountered
.1 60 - BOP - Prevaience
D Oof 6
in a previous study in a university en-
o vironment (Lang et al. 1986) and may
40 -
Blliililil'" 1 of 6
refiect the standard of a prophylactical-
2 of 6
3 of 6 ly oriented semi-rural practice. Also,
4 of 6 during the observation period of 2.5
20 -
5 of 6 years it was found that 2.4% of all sites
6 of 6 lost > 2 mm of probing attachment.
0 - This is substantially more than the 0.8%
Total Reduced Stable Increased of tooth surfaces which lost similar
amounts of attachment during the
3807 41 3735 31 Sites
course of 14 years in a study on perio-
Fig. 8. Difference in probing depth >2 mm during the observation time in relation to BOP dontal maintenance care (Lindhe and
prevalence.
Nyman, 1984). However, the finding
that 2.1 % of all sites yielded >2 mm of
gingival recession in the present study

^^^
and that only 0.8% of the surfaces
showed increased probing depths sug-
gests that the loss of attachment en-
uu - countered may partly have been the ef-
fect of an overzelous toothbrushing.
80 - About 25% (19) of all recessions (81)
mnnnon
affected buccal surfaces, most of them
BOP - Prevalence without clinical signs of gingival inflam-
a> Rn -
mation (13 sites did not bleed at any
., n Oof 6
1 of 6 recall visit, 4 sites bled once, 2 sites bled
40 - ED 2 of 6 2 times). Nevertheless, the fact that
3 of 6 there was a higher number of sites with
4 of 6 recession that sites with increased prob-
20 -
5 of 6 ing depth emphazises the importance of
6 of 6 regular surveillance of toothbrushing
0- techniques during periodontal mainten-
Total Gain Stable Loss ance.
3807 64 3652 91 Sites In 46 sites (1.2%) which scored 6-9
Fig. 9. Difference in attachment level >2 mm during the observation time in relation to BOP mm probing depth at the completion of
prevalence. ' - . . the study, bleeding on probing was quite
 Absence of bleeding 719

frequently observed (Fig. 5). Over 60% pockets > 4 mm appear to bleed more should be instrumented at all recall
of these sites bled 5 or 6 times out of 6 frequently on probing than sites with visits in order to ehminate gingival in-
maintenance visits. In contrast, in the probing depths of less than 4 mm. This fiammation (Lang et al. 1986).
86% of sites (3268) with 1-3 mm prob- may indicate a higher risk for deep The characteristics of diagnostic tests
ing depth, BOP was observed rarely or pockets to lose further attachment than are generally expressed in terms of sensi-
at irregular intervals. This documents shallow sites and would also suggest tivity and specificity as well as positive
that sites with residual periodontal that pockets with deep probing depth and negative predictive value for disease
progression (Fig. 2). In the present
study, these characteristics for BOP as
a diagnostic test have been calculated
for different standards to indicate dis-
E ease progression as well as different
CM threshold levels for a positive diagnostic
Al test. In this respect, loss of attachment
of > 1 mm or > 2 mm respectively were
selected as standards for disease pro-
D All teeth gression, while a positive diagnostic test
H m+d, all teeth of BOP was assessed for both a BOP
^ m+d, side teeth frequency of > 2 or a BOP frequency of
a> > 5 out of 6 maintenance visits. The
'55 results of these calculations showed,
that the sensitivity of BOP as a diagnos-
tic test was influenced both by the selec-
tion of the standard for disease pro-
0 to 1 2 to 4 5 to 6 gression and by the selection of the
Bleeding prevalence (6 recalls) threshold level for a positive test. On
Fig. 10. % of sites with > 2 mm loss of attachment in relation to the BOP prevalence. the other hand, it was noted that the
specificity of BOP as a diagnostic test
was only influenced by the selection of
the threshold level for a positive test
E (Table 3). The highest sensitivity
E (66.7%) was observed when the stan-
20 - dard for disease progression was se-
Al lected to be > 2 mm of loss of attach-
ment and the threshold level for a posi-
o D All teeth tive test was chosen to be a BOP
m+d, all teeih prevalence > 2 out of 6 maintenance
10 - m+d, side teeth visits. For the practitioner, the determi-
nation of the sensitivity and specificity
o of a diagnostic test may be of limited
4-*
value, since these characteristics gener-
"55 ally refiect the probability to have ob-
tained a positive or negative result of
0 to 1 2 to 4 5 to 6 the test under the prerequisite that the
actual status of the patient is known.
Bleeding prevalence (6 recalls) The practioner may, therefore, be more
Fig. 11. % of sites with > 1 mm loss of attachment in relation to the BOP prevalence. interested in the so-called predictive
values of a test, since these refiect the
probability of a disease to progress or
Table 3. % with different standards and test-threshold values. to remain stable. Predictive values pre-
dominantely depend on the selection of
Standard for disease progression LOA > 1 mm LOA > 2 mm
the standard for disease progression.
Positive test: BOP frequency >2 >5 >2 >5
For instance, the positive predictive
true positive 7.5 2.4 1.6 0.7 value in the present study varied be-
false positive 34.4 9.6 40.3 11.3 tween 3.8-5.8%, when a loss of attach-
false negative 9.8 14.9 0.8 1.7 ment of > 2 mm was chosen as the stan-
true negative 48J 73.1 57.3 86,3
dard for disease progression. However,
prevalence 17.3 17.3 2.4 2,4 selecting a standard of > 1 mm loss of
accuracy 55.8 75.5 58.9 87,0 attachment to indicate disease pro-
sensitivity 43.4 13.9 66.7 29,2 gression, positive predictive values of
specificity 58.4 88.4 58.7 88,4 17.9 and 20.0% respectively were found.
5.8 Since predictive values primarily de-
positive predictive value 17.9 20.0 3.8
83.1 98.6 98.1 pend on the prevalence of a disease, it
negative predictive value 83.1
720 Lang et al.

is evident that choosing a standard of Lang et al. (1986) demonstrating that positiven und negativen Voraussagewerte
> 1 mm loss of attachment as a stan- the positive predictive value of BOP (predictive values) beurteilt. Wahrend eine
dard of disease progression covers a generally did not exceed 30%. Higher diagnostische Empfmdlichkeit (sensitivity)
much greater number of sites (17.3%) positive predictive values may probably von nur 29% fiir haufig vorkommendes Blu-
ten beim Sondieren (BOP) berechnet wurde,
than if a loss of attachment > 2 mm is have been achieved in the present pro- betrug die Spezifitat (specificity) 88%. Die
chosen (2.4%). However, in the latter spective study if the patients had been Tatsache, dass der positive Voraussagewert
case, the chance for detecting true loss left untreated. However, because of ethi- (predictive value) fur die Progression der La-
of attachment and thereby coming cal reasons, such data could not be ob- sion nur 6%, der negative Voraussagewert
closer to the "gold standard" is in- tained. On the other hand, the results (predictive value) dagegen 98% betrug, be-
creased, since the measurement error in- of the study clearly show that absence deutet, dass die andauernde Abwesenheit von
herent in pocket probing is most likely of bleeding on probing demonstrated a "Bluten beim Sondieren" ein zuverlassiger
by-passed (Armitage et al. 1977). On the very high probability for the mainten- Pradiktor fur die Erhaltung der parodonta-
other hand, minute loss of attachment ance of periodontal health and hence, len Gesundheit ist.
will be disregarded in this case, which this parameter may be recommended
in turn may explain the low positive for use in daily practice.
predictive value of BOP as a diagnostic When using BOP as a clinical par- Resume
test. It is, therefore, reasonable to dis- ameter for tissue evaluation, especially
cuss the clinical relevance of the nega- during maintenance care, the results of Absence de saignement au sondage. Un indica-
teur de la stabilite parodontale
tive predictive value of BOP as a diag- the present study suggest that non- Suite au traitement parodontal actif, 41 pa-
nostic test. bleeding sites do not need further treat- tients ont eu des rappels tous les 2 a 6 mois
Hence, in the present study, it was ment, while bleeding sites will be over- pendant deux ans et demi. Au debut de cha-
found that BOP had a high negative treated in 4 out of 5 cases when instru- que visite de maintien, les tissus parodontaux
predictive value for disease progression. mented. However, from a clinical point ont ete evalues en utilisant le saignement au
This was clearly reflected by the nega- of view, overtreatment of bleeding sites sondage (BOP). Un nouveau lissage radicu-
tive predictive value of 98.1% found for may be acceptable in patients whit a laire n'a ete effectue qu'au niveau des sites
the frequently bleeding sites (BOP history of periodontal disease. saignant au sondage. Cependant, la plaque
et le tartre sus-gingivaux ont toujours ete en-
prevalence: 5/6 or 6/6), when a "stan-
leves. Les profondeurs de poche et les niveaux
dard" for disease progression of > 2 d'attache au sondage ont ete enregistres suite
mm was chosen. This in turn means that au traitement actif ainsi qu'a la fm de Fetude.
the absence of BOP is a good indicator Acknowledgements La progression de la maladie parodontale a
for the maintenance of periodontal sta- This study has been supported by the ete defmie lorsqu'il y avait une perte d'atta-
bility. Chnical Research Foundation (CFR), che d'au moins 2 mm. La fiabihte du test
Although the sensitivity and positive University of Berne, Switzerland. BOP en tant que signe avant-coureur a ete
predictive value of BOP for loss of evaluee en calculant la sensibilite, la specifi-
attachment was rather low in this study, cite, la precision et les valeurs de presage
positif et negatif. Alors que seulement 29%
this might have been influenced nega- de sensibilite etait calculee comme saigne-
tively even more if the BOP-scoring Zusammenfassung ment frequent, la specificite etait de 88%. Le
would have been performed strictly ac- fait que la valeur de presage positif de la
cording to the method of Ainamo & Abwesenheit von Bluten beim Sondieren. Fin progression de la maladie etait seulement de
Bay (1975) (probing in the gingival crev- Indikator der parodontalen Stabilitdt 6% et que la valeur de presage negatif etait
ice and not to the bottom of the pocket). Nach durchgefiihrter aktiver Parodontalthe- de 98%, rend I'absence continue de BOP un
rapie wurden 41 Patienten wahrend 2 1/2 Jah-
The possibihty of false negative values ren in ein Betreuungsprogamm einbezogen. signe avant-coureur fiable pour le maintien
for BOP would have been even greater Die Abstande zwischen den Prophylaxebesu- d'un parodonte sain.
in pockets with deeper probing depth chen variierten zwischen 2-6 Monaten. Zu
than in more shallow sites. However, Beginn jeder Prophylaxesitzung wurde das
all sulci or pockets were probed to the Vorkommen von "Bluten beim Sondieren" References
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Microscopic evaluation of clinical meas-
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presented by Badersten et al. (1985) and cificity), Genauigkeit (accuracy) sowie der Fletcher RH, Fletcher SW & Wagner EH
 Absence of bleeding 721

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