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| ORIGINAL RESEARCH |
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| Year : 2018 | Volume
: 10
| Issue : 1 | Page : 4-9 |
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GERT index: A modified tooth mobility and treatment index
Lakshmi Puzhankara
Department of Periodontology, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| Date of Web Publication | 26-Feb-2018 |
Correspondence Address:
Dr. Lakshmi Puzhankara
Department of Periodontology, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, AIMS Ponekkara, Kochi, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jioh.jioh_165_17
Aim: Tooth mobility has always been a monumental factor in determining the prognosis of a tooth. There are no indices that link the etiology, grade of mobility, and radiographic appearance with treatment options for mobile teeth. This particular article aims to overcome the oversight and bring in a scoring system that incorporates all the above mentioned components. Materials and Methods: Previously existing index for tooth mobility has been modified (G Score) to make it more defined numerically and clinically, and it has been combined with indices for etiology (E Score) of tooth mobility and radiographic appearance (R Score) of mobile teeth. The Grading Etiology Radiographic appearance (GER) scores have then been allied with a combination of treatment methods (T Score) to get the Grading Etiology Radiographic appearance Treatment (GERT) index. Results: The index that results from this combination is one that encompasses the factors that determine the prognosis and treatment aspects of a mobile tooth. The index given in this article takes into consideration the components that contribute to the diagnosis of the etiology of tooth mobility such the clinical presentation and the radiographic appearance. The grade of mobility has been modified to allow for precise numerical assessment of mobility. Thus, the treatment plan proposed considers the basic cause for the mobility and the comprehensive treatment modality for the same. Conclusion: Although the index appears elaborate, once mastered, it would pave the way for a thorough treatment planning for mobile teeth and efficient execution of the treatment plan.
Keywords: Coronoplasty, etiology of mobility, grade of mobility, splinting
How to cite this article:
Puzhankara L. GERT index: A modified tooth mobility and treatment index. J Int Oral Health 2018;10:4-9 |
| Introduction | |  |
Tooth mobility heralds the beginning of destructive periodontal disease. Most patients report to the dentist with an increased tooth mobility or an increasing tooth mobility. An increased tooth mobility is usually an adaptive response of periodontium to occlusal trauma, and it may not necessarily be pathologic.[1] An increasing tooth mobility, on the other hand, is the result of inflammation of the periodontium and the subsequent bone loss.[1]
An ideal treatment plan for tooth mobility requires knowledge of the etiology of mobility and an understanding of the prognosis of the tooth. There are several indices that help to numerically describe the extent of tooth mobility.[2] However, indices that combine the etiology, grade of mobility, and possible treatment plan for each situation has not yet been formulated.
This article presents a new index combining the etiology of mobility (E score), the grade of mobility (G Score), radiographic appearance (R Score), and treatment plan (T Score) for the mobile teeth. The GERT score would help even a novice practitioner arrive at an appropriate treatment plan for the mobile teeth.
| Materials and Methods | | |
The index
The index that is being proposed in this article has four components as mentioned earlier: Etiology, Grade of Mobility, Radiographic appearance, and Treatment plan.
Etiology
Both local, as well as systemic factors, contribute toward tooth mobility. The etiology can be graded from EL1-EL13 for mobility caused by local factors and from ES1-ES5 for mobility caused by systemic factors [Table 1]a and [Table 1]b.
Grade of mobility
Several indices have been put forward to measure the tooth mobility. Miller's tooth mobility index, mobility index proposed by Waserman et al., and Nyman's tooth mobility index are a few. The GERT score utilizes a modification of Nyman's tooth mobility index. The modified index is given in [Table 2].
Radiographic appearance
Varied radiographic appearance is seen with different etiologies of tooth mobility. The radiographic features hold a significant influence over diagnosis and treatment planning. The grading based on radiographic appearance is given in [Table 3].
Treatment
The treatment for tooth mobility requires a thorough evaluation of the case and an infallible treatment planning. The grades for the different treatment modalities are given in [Table 4].
The GERT index
Several permutations of the GER scores may be seen during clinical examination of a patient. Each combination will in turn have a few plausible T scores. The knowledge of the various GERT combinations would allow the clinician to treat patients with impunity. The GERT index is given in [Table 5]a and [Table 5]b.
| Discussion | | |
The GERT index incorporates into it the various etiologies of tooth mobility. It is a well-known fact that periodontitis, trauma from occlusion, parafunctional habits, periapical pathology, traumatic injuries to the tooth, certain systemic diseases such as diabetes and conditions such as pregnancy can result in tooth mobility.[6],[7],[8],[9] In some cases, trauma from occlusion may cause an increase in tooth mobility which may be an adaptation to the excessive occlusal forces and may not necessarily be pathologic.[10] The exact etiology of the tooth mobility has to be discerned to delineate an appropriate treatment plan.
The role of radiographs in the scheme of diagnosis is paramount. The radiographic appearance of periodontal, periapical, and skeletal disturbances of the jaws, if interpreted carefully, would lead to the development of management protocols as required by the clinical condition.[11] However, in case of periodontal disease, it is essential that a differentiation between treated and untreated periodontitis be made. Only in the absence of a normal clear-cut peripheral outline of the septa, can the radiograph be considered to indicate active periodontal destruction even if the level of bone height is reduced.[12]
Miller's mobility index is a very commonly used index. However, a more mathematical index would be helpful for the clinician in calculating the grade of mobility precisely. The classification by Nyman et al. has a more numerical expression. However, the index by Nyman et al. does not provide for the depressibility or vertical mobility in teeth with 1–2 mm mobility, neither does it provide for the horizontal and vertical mobility ranging from 2 to 3 mm. Hence, a modification of the Nyman index has been proposed in this article that incorporates a separate vertical mobility component for teeth with mobility ranging from 1 to 2 mm and a vertical and horizontal mobility component for teeth with mobility ranging from 2 to 3 mm. This would help in resolving the misperception regarding the management of teeth with vertical mobility but having only 1–2-mm horizontal mobility, and also in determining the prognosis of teeth with 2–3-mm horizontal mobility but no vertical mobility.
The grading of the various treatment options has been done after considering the varied etiologies of tooth mobility. Correction of the root cause of mobility is crucial for successful treatment. For example, in the presence of periodontitis, the removal of the infected granulation tissue is essential while in the case of periapical and periodontal abscesses, drainage of the abscess along with the administration of endodontic therapy and other anti-infective therapies as deemed necessary will aid considerably in reduction of tooth mobility; correction of trauma from occlusion requires identification of the etiology followed by its removal,[13] coronoplasty, restoration, or orthodontic correction. Elimination of the etiology of mobility followed by stabilization of mobile teeth is a prerequisite for management of mobile teeth. Splinting is done to stabilize the mobile teeth and is usually considered after the management of the core etiology of mobility.[14] Extracorporeal shock wave therapy has been shown to reduce the tooth mobility more quickly in postorthodontic treatment patients,[15] and appropriately planned prosthetic therapy can avoid periodontal disease.[16]
The GER score combines the three components stated previously. For each GER score, specific amalgamations of T-scores have been proposed. However, during clinical examination of a patient, several combinations of GER scores might be observed, and therefore, different treatment options will have to be adopted. The GERT index is thus, versatile and flexible and allows for a multi-element treatment approach.
| Conclusion | | |
The GERT index is a new index that expounds the linking of the grade of mobility, its etiology, radiographic appearance, and treatment plan and would be an invaluable addition to the existing repertoire of indices for tooth mobility. The components of the index would, at a glance, appear to be too elaborate. However, a detailed study of the same would help the clinician recognize the advantage of bracketing the various components together. Once familiar with the components, a mere glimpse at the index would help the clinician formulate a treatment plan encompassing all aspects of tooth mobility. However, further studies are required to check the validity and reliability of the index and to facilitate its application in clinical practice.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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