Author Archives: Judy Carroll

PerioEndoscopy and Integrative Care

PerioEndoscopy and Integrative Care – Case Studies for discussion:

We have created this blog page to post pics and comprehensive information on actual PerioPeak case studies for the purpose of more in-depth clinical education and sharing of knowledge.  Professionals and patients are welcome and encouraged to post here.

Case #1:

I will be seeing this patient soon traveling in from out of state. He has had blind root planing 4 times in past 18 months. Twice with the periodontist. He was told he has “rough roots”. While he was told to get a “physical”, he was not given a list of labs to check for causal risk factors such as D deficiency or other. I have requested comprehensive labs on him before treating him in April. I will also run a full genetic panel and pathogen test since no one has done this. This pt has hx of ortho, excellent diet, BMI wnl, no family hx of anything, has NG. He’s only 32. Pockets are gen 5-6mm with gen. BOP and severe infl as you can see, gen early to moderate horizontal bone loss on x-rays. We expect to find residual ortho cement sub-g in many areas.  He does have seasonal allergies and there are mouth breathing and myofunctional issues as part of overall risk factors (bruxism as well). He is lactose intolerant and takes a high potency multivitamin daily.  I have seen cases like this in the past (non-responsive, hyper-inflammatory), in my experience it always seems to be young males who are “type A” personality, there is also a genetic component. His mom has had hx of perio issues, father HBP but is overweight. Rarely do these individuals have pathogens.  We will be looking closely into all systemic issues, including adrenals. Comments? I will post test results and findings next month once I have all the data.

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Update – here is what we determined:  As I suspected this patients bacteria profile is very clean, no pathogens.  His genetic profile is positive for IL6, TNF alpha and IL17A polymorphism (he has hyper-inflammatory immune response).  He was diagnosed with severe vitamin D deficiency and is now taking high doses.  Upon clinical exam chronic mouth breathing was determined (along with tongue thrusting and clenching), with suspected sleep apnea.  We referred him to the ENT right away for severe obstructive airway issues.  We recommend he continue on Periostat and high doses of D3.

Viruses and Their Role in Periodontal Diseases

Could your chronic periodontal disease involve viruses?

Periodontal diseases can involve bacteria and/or viruses initiating chronic inflammation and ensuing tissue and bone destruction.  Patients with history of herpes simplex virus (HSV) or Epstein Barr virus (EBV) are especially high risk for the presence of these putative pathogens. We do not currently have oral salivary  DNA tests to either confirm or refute the presence of viruses in the risk factor assessment of active periodontitis, but blood tests can be performed for the presence of antibodies.  To date the only way to combat oral viruses is to have definitive periodontal treatment to eliminate periodontal pockets and utilize a diluted bleach solution at home (1/20 bleach with water).

Biology and Pathogenesis of Cytomegalovirus in Periodontal Disease:

Periodontol 2000. 2014 Feb;64(1):40-56. doi: 10.1111/j.1600-0757.2012.00448.x.
Biology and pathogenesis of cytomegalovirus in periodontal disease.
Contreras A, Botero JE, Slots J.
Abstract

Human periodontitis is associated with a wide range of bacteria and viruses and with complex innate and adaptive immune responses. Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, Treponema denticola, cytomegalovirus and other herpesviruses are major suspected pathogens of periodontitis, and a combined herpesvirus-bacterial periodontal infection can potentially explain major clinical features of the disease. Cytomegalovirus infects periodontal macrophages and T-cells and elicits a release of interleukin-1β and tumor necrosis factor-α. These proinflammatory cytokines play an important role in the host defense against the virus, but they also have the potential to induce alveolar bone resorption and loss of periodontal ligament. Gingival fibroblasts infected with cytomegalovirus also exhibit diminished collagen production and release of an increased level of matrix metalloproteinases.  This article reviews innate and adaptive immunity to cytomegalovirus and suggests that immune responses towards cytomegalovirus can play roles in controlling, as well as in exacerbating, destructive periodontal disease.

Regenerative Periodontal Endoscopy℠: Before and after pictures and x-rays

How Regenerative Periodontal Endoscopy℠ Works:

Regenerative Periodontal Endoscopy℠, or RPE℠, is an advanced non surgical endoscope procedure pioneered and offered by PerioPeak Innovations.  The skilled use of a periodontal endoscope, micro-ultrasonic piezo technology, and regenerative proteins can eliminate the need for aggressive surgery.   When used properly, endoscope technology allows for pinpoint precision and the complete removal of gum infection and tartar in deep pockets without surgery.   Emdogain, a natural regenerative protein,  is then placed on properly prepared root surfaces in all deep gum pockets to stimulate the body’s own regenerative stem cells, reduce inflammation, inhibit growth of bacteria, aid in the reattachment of the gums, and promote bone fill.  Safe and effective anti-inflammatory medication is used to promote more rapid healing and stability of the gums by resetting the inflammatory response and boosting activation of regenerative cells.

To understand more about the research and science behind this advanced protocol click here.

Watch this procedure on You Tube.

More cases:   Perioscopy Case Studies, Before and After pictures,    Advanced Cases.

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RPE℠ is completed in one appointment with local anesthetic, there is no need for repetitive visits as with other periodontal treatment modalitites.  There is no pain and no down time following RPE℠, making it very convenient for our many clients traveling in from out of state.  Our clients do not need to alter their diet and they do not experience root sensitivity following RPE℠.  Remarkable clinical results are achieved without surgery, including closure of deep gum pockets and bone fill.   RPE℠ is a definitive and affordable treatment option which can reduce or eliminate the need for periodontal surgery and extractions.  View our long list of testimonials and request references.

Before and after pictures and x-rays of actual RPE℠:

before RPE℠  10-12mm pockets  #2, #3           6 mo’s after RPE℠ – bone fill, no pockets

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before RPE℠  – 8mm  bony defect           10 months after RPE℠ – bone regenerated

very advanced bone loss 12mm      10 months after RPE℠- nice  bone fill

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      Before RPE                                                         6 months after RPE

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Above – Before RPE℠ – 12mm pocket –  advanced bone loss – this patient was advised by his periodontist he needed to have this tooth extracted and an implant placed.  He chose RPE℠ as a less invasive, more affordable option- see result below.


3  months after RPE℠ – normal healthy tissue 3mm- bone fill well underway, no mobility, and no need for an extraction and implant.  This tooth was treated in 2006 and is still healthy.  This patient saved thousands of dollars in treatment costs by avoiding an extraction, bone graft,  implant, and crown.

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Advanced furcation #18 – 10mm pocket       6 months after RPE – 3mm (x-rays below)

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#18 before RPE (advanced bone loss)            6 months after – nice bone fill

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Same patient other side #31 9mm furcation    6 months after RPE – 3mm (x-rays below)

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Before RPE                                                      6 months after RPE – nice bone fill

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Before RPE℠ – 10mm pocket (x-ray below)             after RPE℠ – 1-2mm (x-ray below)

(This patient is a heavy smoker)

  excellent-bone-fill-6-mo

Before RPE℠ – very advanced bone loss        6 mo’s after RPE℠ – remarkable bone fill

Before RPE℠-  10mm pocket (x-ray above)                        After RPE℠ – 1mm (x-ray above)

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Before RPE℠  – advanced bone loss                    4 months after – complete bone fill

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Before RPE℠ 13mm (advanced furcation)       6 months after RPE℠ – 2mm – healthy

Before RPE℠ – 13mm advanced furcation          6 months after RPE℠ – 2mm

Before RPE℠ – 11mm  (advanced mobility)       6 months after RPE℠ – 2mm -solid

see before and after x-rays below

Before RPE℠  – 19 considered “hopeless”                Bone fill 6 months after RPE℠ (pics above)

Before RPE℠ advanced bone loss          6 months after RPE℠ – nice bone fill – see the photos for this tooth below

Before RPE℠ – 10mm                                                 6 months after RPE℠ – 2mm

before RPE℠ and root canal therapy (8-11mm)       6 months after (1-3mm) – health restored

pics are for x-rays above – before – 10mm                          6 months after RPE℠ – 2mm

Before RPE℠ – advanced bone loss #4                      6 months after RPE℠ – nice bone fill

Before RPE℠ – 9mm furcation                                  6 months after RPE℠ – 2mm – healthy

Before RPE℠ – 7mm                                                  6 months after RPE℠ – 2mm -healthy

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Before – 10mm pockets tooth#10         15 mo’s after RPE℠ – 3mm- no mobility

The patient above was told she needed to have this tooth extracted and an implant and crown placed.  She was also treatment planned for full mouth osseous periodontal surgery for multiple infections and deep pockets.   Instead, she chose the option of RPE℠.  She was able to avoid spending $12,000 for the full mouth surgery and the added expense of having an implant placed.  Her total cost for full mouth RPE℠ treatment was only $3000.


Before 10mm                                                                         after 3mm

The above result has been maintained since 2006.

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IMG_0863  IMG_4859

Before full mouth RPE -advanced case with generalized deep pockets – 3 years after RPE, complete health restored.  More photos of this case below:

IMG_0869  IMG_4862

Before RPE                                                         3 years after RPE

IMG_0873  IMG_4865

before RPE 7mm pocket                                 3 years after RPE 3mm

IMG_0876  IMG_4864

before RPE – 7mm                                              3 years after RPE – 3mm

The patient above was told due to her hopeless advanced periodontal disease she would eventually lose all of her teeth.  She was very embarrassed to smile due to shifting of the teeth from the advanced bone loss with deep pockets and was emotionally devastated before coming to PerioPeak.  She now has tight healthy tissues with no mobility and no bleeding.  This patient underwent orthodontic treatment after RPE to correct extrusions and malocclusion.  She is elated with her results!

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Before –  7mm pocket                            3 months after RPE℠- bone filled in

The patient above was facing the loss of her entire bridge due to advanced periodontal bone loss, 3 months after RPE℠ she no longer had to worry.  Health restored to the gums with nice bone fill on the x-ray.

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(above) before – 10mm pockets                                (above) 3 months after RPE℠ – 3-4mm

the patient above was able to avoid extraction of the molar tooth, thus saving the bridge.  She was able to avoid having an implant placed, followed by a new bridge for this area.

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before RPE℠ – extraction of 18 imminent          1 year after RPE℠ – her dentist sent us this x-ray with nice bone fill

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Nelly LL before best x-ray Nelly LL after best x-ray

Before RPE℠ – 10mm (19 & 20)                               1 yr after RPE℠ – bone filled in -health restored

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The case study below demonstrates well the speed at which healing occurs with RPE℠.

(above) Before – 8mm                                     2 weeks after RPE℠ – 3mm – x-rays below

 

Before x-ray #28 mesial                                             8 weeks after RPE℠ – rapid bone fill is evident

Before – painful abscess 7mm                                  2 weeks after – 1mm – health restored

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Before – 7mm pockets – tongue stud damage      Bone fill 6 weeks later

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tongue stud damage – facing extractions       6 months after RPE℠ – health restored

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Before RPE℠ – 10mm                                                   6 months after RPE℠ – 1mm

Before RPE℠ – 11mm with heavy bleeding and a periodontal abscess clearly seen – 6 months after RPE℠ 2mm very tight healthy tissue – see bone fill on x-rays below.

Before RPE℠ – class II mobility                     6 months after RPE℠ – nice bone fill

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Before 11mm pockets                                          bone fill at 6 months

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Before – 10mm pocket 19 mesial                                        6 months after, nice bone fill, 4mm.

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23D before 10mm 23 after 3months

Before RPE℠ – 10mm                             3 months after – 3mm (see x-rays below)

23 before 23 after 6 wks

Before RPE℠                                       6 weeks after – good bone fill occurring

23 before lingual 23 after lingual

before RPE℠ – 10mm                                               3 months after RPE℠ – 2mm

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30D before 30D after

Before RPE℠ – 10mm                                                                3 mo’s after RPE℠ – 3mm

30 DL before 30DL after

Before RPE℠ – 12mm                                                    3 mo’s after RPE℠ – 4mm (see x-rays below)

da30big 30 3 mo after x-ray

Before RPE℠ (is tooth fractured?)                   3 mo’s after, slight bone fill – no fracture detected

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Before RPE℠ – 10mm                                      6 months after – nice bone fill occuring – 3mm

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Before RPE℠ – 10mm             7 months after RPE℠ – no mobility – 3mm

The above tooth was treatment planned for extraction by the periodontist.  #31 presented with a 10mm distal defect, a 10mm furcation on the buccal, and mobility.  Only 7 months after RPE℠, all periodontal probings are normal, there is no mobility, and the tissue is tight and healthy.

The RPE℠ protocol is very specifically designed to arrest the chronic inflammation associated with periodontal disease, allowing long term healing and restoration of the gums to occur.  RPE℠ goes beyond the short term results seen with traditional non surgical treatment strategies – including the overuse of oral or locally applied antibiotics, and/or traditional laser periodontal therapy. View more case pictures.

One third of the population has a genetic tendency to develop periodontal disease, one half of those individuals will develop advanced periodontal disease, resulting in tooth loss.  RPE℠ can effectively interrupt and reverse this grim outcome for millions of individuals.

While no formal research yet exists on this innovative approach, there is impressive research on each technology studied independently, demonstrating efficacy in the treatment of periodontal disease.  Pairing these technologies properly promotes “synergy” – the phenomenon in which the combined action of two or more things is greater than the sum of their effects individually.  Because periodontal disease is multi-factoral, it can typically be more effectively treated using a synergistic approach.

Contact us for a complimentary consultation

For more information about sub-antimicrobial dose doxycyline 20mg go to host modulated therapy.

For more information about  regenerative proteins (Emdogain) go to http://periopeak.com/blog/category/bone-regeneration/

Advanced Periodontal Disease Pictures – Successful Treatment Without Surgery – Implant Alternative

Pictures of Advanced Gum Disease Treatment  – pictures taken by PerioPeak Innovations


Above:  Before non surgical Regenerative Periodontal Endoscopy℠ (RPE℠) -bleeding and infected 15mm pocket tooth #6.  This patient was advised by three different periodontists that due to the advanced nature of his periodontal disease he needed all of his teeth extracted.


Above:  3 months after RPE℠ – 4mm – very healthy tissue – no bleeding.  This patient has remained stable and healthy for many years.   See more pics below, or  Learn more about this unique protocol.

 


Above:  Before RPE℠ – 9mm infected advanced periodontal pocket- tooth #8 is very loose


Above:  After RPE℠ – 2mm, healthy, no bleeding, no mobility.

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Before RPE℠ – severe inflammation – 7mm pocket tooth #26.  This patient was also told she needed full mouth extractions due to the advanced periodontal disease on all the teeth. (she had generalized 5-12mm pockets).


After Regenerative Periodontal Endoscopy℠ -RPE℠:   minimal inflammation – pink, healthy tissue – 3mm measurements – health restored to all her gum tissues.  No longer a need for full mouth extractions.


Before – 10mm – this patient was treament planned for extractions by her periodontist.


3 weeks after RPE℠ – 3mm tight, healthy tissue – no need for extractions.


Before – 7mm – severe inflammation


3 weeks after RPE℠ – 2mm – very healthy tissue


Before – 11mm pockets #24 and #25


After RPE℠ – 2mm – healthy

Read how Regenerative Periondontal Endoscopy works

or watch our You Tube Video 

 

Comparison Pictures of Periodontal Surgery vs. RPE℠ Below:   

Left: This patient underwent periodontal surgery (osseous surgery) for her advanced periodontal disease (she had 5-9mm pockets generalized) – this picture is 6 months after undergoing periodontal surgery.

Above: This patient had 5-9mm pockets generalized but instead of having the periodontal surgery recommended by her periodontist, she had non-surgical RPE℠.  This picture is 6 months after RPE℠.  No tissue and bone is removed as in the periodontal surgery picture.  A superior cosmetic outcome is the result – with no gaps between the teeth and no recession of the gums.

RPE℠ is a conservative treatment approach which does not cause the disfigurement often associated with aggressive periodontal surgery.  The two cases presented above had identical pocket depths.  One patient underwent traditional osseous periodontal surgery, the other chose RPE℠.  The difference in results is obvious.  Unfortunately for many patients who have undergone periodontal surgery, the gum and bone is removed (cut out) to reduce periodontal pockets –  in doing so the roots are exposed causing disfigurement of the gums (black triangles and recession).

Periodontal surgery picture below (warning – this photo may be disturbing):

Below:  Regenerative Periodontal Endoscopy℠ Procedure – RPE℠.

The miniature fiber optic used in this picture enables our highly skilled clinicians to clean all root surfaces without the need for flap/osseous periodontal surgery.  There is no need for bone and tissue removal as in osseous periodontal surgery.  Instead, all infected gum tissue in deep pockets is gently removed with micro-ultrasonics,  regenerative proteins are then placed on the roots to stimulate adult stem cells – promoting closure of periodontal pockets.  Healing is accelerated due to the conservative nature of the procedure and the addition of host modulated therapy.  Since there is no trauma to the tissue, the disfigurement and recession often associated with traditional periodontal surgery does not occur with RPE℠.

Pancreatic Cancer and Periodontal Disease

Pancreatic Cancer linked to Gum Disease?

Scientists have recently discovered what appears to be a definitive link between pancreatic cancer and periodontal (gum) disease. Pancreatic cancer is the fourth leading cause of cancer deaths in the U.S. because it is so difficult to treat. More than 300,000 Americans are expected to die from it this year.

The study found that men with periodontal disease have a 63% greater risk of developing deadly pancreatic cancer. The research studied 51,000 professional non-smoking males from 1986 to 2002. It may be that the chronic inflammation from periodontal disease is setting off an inflammatory response which is detrimental to overall health, or that the bacteria associated with periodontal diseases are the culprit. More research is needed to determine the actual action periodontal disease has in creating a higher risk of cancer.

At PerioPeak Innovations we are committed to addressing chronic periodontal disease and the inflammation associated with it proactively and definitively.  By using a synergistic approach, involving advanced miniature fiberoptic technology and host modulated therapy, the periodontal inflammation can very effectively be put into a remissive state for the long term…lowering the overall health risks associated with all stages of periodontitis, or gum disease.

Below are recent articles about the link between periodontal disease and pancreatic cancer:

http://abcnews.go.com/GMA/OnCall/story?id=2813658&CMP=OTC-RSSFeeds0312

http://www.medicalnewstoday.com/medicalnews.php?newsid=60977&nfid=rssfeeds

http://www.healthcentral.com/newsdetail/408/601047.html

How does Perioscopy Work?

How does Perioscopy, or periodontal endoscopy, technology work?

Periodontal endoscope technology, or Perioscopy, is an important part of the PerioPeak protocol, RPE℠ – Regenerative Periodontal Endoscopy℠.  It is a crucial component to achieving excellent overall results for many reasons.  Periodontal endoscopy is a non-invasive way to view and clean root surfaces microscopically in all depths of pockets, without performing surgery, using micro-ultrasonic technology simultaneously.

Important: We prefer the term “periodontal endoscopy” rather than the commercial trademark term “perioscopy”, which over the years has become a term associated with “removing calculus only”.  We view this narrowly focused use of the periodontal endsocope as antiquated use of the technology.

The dental endoscope, or periodontal endoscope, is a fiber optic is less than 1mm in diameter, it incorporates powerful illumination with 48X magnification.  It is essentially employing the use of a miniature microscope under the gums. The image is viewed live on a high resolution flat panel color monitor. It takes a great deal of  experience to perform periodontal endoscopy procedures (diagnosis and periodontal treatment) with proficiency.  PerioPeak Innovations has provided this treatment successfully for over a decade on hundreds of clients with advanced periodontal disease.

Below are four still endoscopic pictures viewing the area between the root and gums (deep gum pocket) during a periodontal endsocopy procedure.  Click on images to enlarge

click on image to enlarge

SCI 3:  Subgingival Calculus Index 3 is calculus that extends beyond the plane of the root, it can be felt and possibly seen in x-rays (radiographic calculus).

click on image to enlarge

SCI 2:  Subgingival Calculus Index 2 is calculus which cannot be felt with instruments (explorers) beneath the gum line…also known as burnished calculus (tartar).  This tartar left behind following traditional root planing because it is very smooth and can fill in the tooth depressions, furcations, and flutings in the roots.

Burnished tartar is typically left on the roots following traditional root planing. Burnished calculus cannot be seen or felt with traditional techniques beyond a depth of 4mm.   30-50% of the root may have residual calculus; infection and inflammation may persist.

click on image to enlarge

SCI 1:  Subgingival Calculus Index 1 is microscopic calculus which cannot be seen or felt, even with direct vision, as in surgery.  Commonly referred to as “glitter”, SCI 1 is found in all depths of pockets and even on exposed recessed root surfaces – inflammation may persist.

The presence of microscopic calculus can be identified and removed by experienced individuals using a periodontal endoscope. Surgical microscopes and loupes (magnified glasses) do not reveal this truth because they do not incorporate 48X magnification with tremendous illumination.  In addition, a surgical microscope cannot be placed beneath the gums.

Note: Only a scanning electron microscope on extracted teeth will reveal this detail.

click on image to enlarge

SCIO:  Sub-gingival Calculus Index Zero is what we refer to as “microscopically clean”.

The limitations of current traditional techniques, such as root planing, was unknown until the innovation of the periodontal endoscope. Using lasers beneath the gum blindly, root planing tactilely in deep pockets, or performing periodontal surgery without an endoscope, may allow toxic calculus to remain embedded in the roots, hence, periodontal inflammation and infection may continue.

Endoscope Assisted Bone Regeneration with Emdogain

Regenerative Periodontal Endoscopy℠  (RPE℠) – Periodontal endoscopy and Emdogain

Non-surgical periodontal bone fill is finally possible thanks to a new biological technology called Emdogain, by Straumann. But what is Emdogain and how does it work? The following post will help clarify what Emdogain is and also help the reader to understand the tremendous benefits of endoscope assisted regeneration using this natural protein.

IMPORTANT: Emdogain is used non surgically at PerioPeak Innovations with an innovative technique and protocol utilizing a periodontal endoscope, soft tissue laser,  micro-piezo ultrasonics, and enzyme inhibitors. Emdogain is typically used only during some type of flap periodontal surgery procedure.  However, a recent study demonstrates histological bone regeneration with Emdogain used in a non surgical periodontal therapy approach.

So what exactly is Emdogain?

Emdogain contains Enamel Matrix Protiens, or Bioactive Molecules, called amelogenin proteins, which are harvested from the developing teeth of pigs.  What are enamel matrix proteins and how do they help humans to regenerate periodontal tissues and bone? The answer is in the unique biology of tooth development. When teeth are still developing, we can extract these “bioactive molecules” and use them in humans for the stimulation of adult stem cells to promote regeneration in periodontal defects created by chronic or acute infections of the gums.  The body responds by growing new cementum, ligament, and bone (osteogenesis) in areas where periodontal disease has damaged these important supporting structures. The damage of periodontal disease can be repaired and reversed with Emdogain.

Read easy to understand information about Emdogain

The Mechanism of Emdogain:

Attachment – the mesenchymal cells attach to the root surface covered by Emdogain.

Proliferation and Growth -the cells start to produce cementum. Cementum is the key tissue in periodontal regeneration. The recreation of alveolar bone starts from the root cementum.

Alveolar Bone – the process of mineralization starts a certain distance from the root and alveolar bone (periodontal bone around the teeth) is formed.

Note:  Efficient piezo microscopic root debridement (proper root preparation) and laser soft tissue curettage are guided by the use of a periodontal endoscope with 48X magnification.    

View non-surgical bone restoration cases using endoscope assisted RPE℠ techniques instead of surgery.

The DV2 Dental Endoscope with 48X Magnification is used to definitively access and clean all root surfaces prior to the placement of Emdogain with this non surgical technique.

Summary of the Clinical Benefits of Emdogain:

Case Report

Clinical and Histologic Evaluation of Non-Surgical
Periodontal Therapy With Enamel Matrix
Derivative: A Report of Four Cases

James T. Mellonig,* Pilar Valderrama,* Holly J. Gregory,* and David L. Cochran*  (read entire paper)

EMD stimulates fibroblast proliferation, the growth of periodontal ligament (PDL) cells, osteogenesis, and the proliferation and differentiation of osteoblasts;  it also prolongs osteoblast growth and enhances trabecular bone regeneration, promotes osteoprotegerin production, and enhances osteopontin expression and transforming growth factor-beta1 production. EMD stimulates bone sialoprotein, signal transduction of bone morphogenetic protein, release of vascular endothelial growth factor, and angiogenesis. EMD also has anti-inflammatory properties. It limits the release of proinflammatory cytokines, modulates tumor necrosis factor-alpha and prostaglandin, and inhibits caspase activation. EMD has a negative effect on the growth of periodontal pathogens and might be useful as an antiadhesive agent for breast cancer cells.

The history of Emdogain:

– 1988 Biora founded by Professor Lars Hammerstrom, Stockholm Sweden.

– 1995 CE Certification

– 1996 FDA approval- 1997 introduction into the US market.

– Since 1989 produced in Malmo Sweden

– 2004 completion of integration by Straumann.

There are numerous studies involving the safety, efficacy, and statistical clinical significance with Emdogain.  Over one million people have been treated successfully with Emdogain.  Go to www.straumann.com for more information.

 

 

Genetic risk factor’s for Periodontal Disease

Could my periodontal disease be genetic?

One third of the population have a genetic tendency to develop periodontal disease.  One half of these individuals will develop the advanced stages of periodontal disease. Many people are born with a “sensitivity” to plaque bacteria – making their periodontal disease much worse due to a “hyper-inflammatory immune response”.  One could describe it as an “allergy” or even an “auto-immune response”.  The body goes into a very destructive chronic inflammatory response. For these individuals the presence of plaque bacteria (biofilm) causes inflammation on contact, triggering the immune system to go into hyper-drive, leading to periodontal destruction.  This hyper-inflammatory immune response creates an over-production of harmful enzymes, allowing chronic periodontal bone loss and tissue destruction to ensue.  It’s important to also realize that this genetic mutation will actually create periodontal destruction, even in the absence of, or in the presence of minimal amounts of periodontal pathogens. 

 

How can I find out if my periodontal disease is genetic (genetic polymorphism)?

A simple genetic test called a PST or Perio ID can be performed to determine genetic susceptibility.

Salivary DNA testing identifies patients genetically predisposed to severe periodontal disease. Early detection of patients at increased risk facilitates prevention/early intervention efforts. For those patients already affected with periodontal disease, the Oral DNA Perio ID test assists a clinician in creating a personalized treatment plan. The information gained from this test can be useful for all dental and medical professionals and their patients, leading to more targeted therapy.

The Oral DNA Perio ID test detects specific variations in the IL 6 gene. The presence of this variation (mutation or polymorphism) increases the risk for periodontal disease 3 to 7-fold and for tooth loss 3-fold. The combination of an IL 6 positive test result and smoking or other risk factors such as hyperglycemia or deficiencies leads to an even greater likelihood for severe periodontal disease and early tooth loss.

What it means to be IL6 positive (genotype G/G – high risk):

Significance: The prevalence of the G/G genotype is reported to be higher in individuals with
moderate to severe chronic periodontitis and aggressive periodontitis than in individuals with no periodontal disease. This finding was independent of other risk factors such as age, smoking,
ethnic origin. The G allele is associated with overproduction of interleukin-6 (IL-6) cytokine in the
presence of pathogenic periodontal bacteria.
Risk: Individuals carrying an IL6 G allele are associated with increased odds of the concomitant
detection of A. actinomycetemcomitans, P. gingivalis and T. forsynthensis.
Consider: IL-6 is a potent stimulator of osteoclast differentiation and bone resorption, is an
inhibitor of bone formation, and overproduction has been implicated in systemic diseases such
as juvenile chronic arthritis, rheumatoid arthritis, osteoporosis, Paget’s disease and Sjogren’s
syndrome. The MyPerioID test assesses one of several risk factors that should be included in an
overall evaluation of periodontal disease. Specific bacteria are associated with the initiation of
the periodontal disease. Additional risk factors including other genetic markers, smoking,
diabetes, and oral hygiene have an amplifying effect on disease progression and duration. The
incidence of IL6 genotypes is reported to vary by ethnicity.

 

Patients with positive PST results overproduce the 2 active forms of interleukin 1, IL-1α and IL-1β.  What does this mean?

According to Carranza in the 9th Edition of Clinical Periodontology, IL-1 is one of the pro-inflammatory cytokines that has a central role in tissue destruction.

IL-1 is typically produced by PMN’s (polymorphic neutrophils) in response to a bacterial challenge (periodontal pathogens).  However, in the absence of periodontal pathogens, the genetic situation of the patient causes the IL-1 production.  To make matters worse, IL-1 up-regulates its own production, resulting in even more production of the cytokine.

IL-1 stimulates endothelial cells to produce chemical mediators that recruit macrophages to the site.  The macrophages are then induced to produce prostaglandin E2 (PGE2), which causes periodontal bone loss.  IL-1 is also a potent stimulant of osteoclast proliferation, differentiation and activation.  As well as inducing periodontal bone loss, IL-1 also induces production of proteinases in mesenchymal cells, including MMP’s, which may contribute to connective tissue destruction.  Matrix metalloproteinases (MMP’s) degrade extracellular matrix molecules, such as collagen, gelatin, and elastin.

The bottom line here is that people with the genetic profile are predisposed to exhibit periodontal bone and tissue loss, even in the presence of few periodontal pathogens (regardless of virulence) and even if they have good home care.  Host response is a major risk factor for chronic inflammation and continued periodontal breakdown.

Go to www.oraldnalabs.com for more information on genetic testing, as well as the DNA pathogen testing we provide.

For more information on genetics and periodontal disease go to these sites:

www.perio.org
www.dentistry.com
www.umm.edu

What is the outlook for genetically inclined individuals?  

The good news is that advanced technologies (such as anti-inflammatory medications, periodontal endoscope treatment, and comprehensive integrative care) will now allow us to alter the predictably poor outcome of genetic periodontal disease.  These individuals are typically blamed for having poor home care, which is not always true.  Strong risk factors such as genetics must be addressed more definitively to effectively put periodontal disease into remission. No longer will only cutting the pockets out with gum surgery, or only doing blind or visual root planing, be the entire solution for these individuals.  A synergistic approach must be incorporated involving addressing the hyper-inflammatory response.  Utilizing a multifaceted approach is absolutely necessary for the successful long term management of the periodontal disease in these individuals.

Is genetic periodontal disease like an auto-immune disease?  YES

Individuals with a genetic predisposition must be identified before anything we do clinically will be successful long term. This type of disease is characterized by the over-production of destructive enzymes which causes severe destruction of the bone and gums supporting the teeth. The chronic and subtle nature of this type of disease can fool even the most astute clinician. Damage can occur quickly or slowly, therefore, preventative and more definitive care becomes crucial.  These individuals must be treated as if they have an auto-immune disease.

For more information about our non invasive periodontal protocol go to How RPE℠ works