Pictures and x-rays of periodontal disease and bone loss -

Stages of Periodontal Disease:

Early periodontal disease may be characterized by swelling and redness of the gums and early horizontal bone loss, but is usually not associated with loss of gum tissues, or gum recession.

Early horizontal bone loss around the teeth can be seen on the x-rays below.  Typical gum pocket depths would be 4-5mm.  Bleeding when measuring (probing) may be present.

x-ray demonstrating early periodontal stage periodontal bone loss

Moderate Periodontal Disease: below

6mm gum pocket on tooth #7

5mm gum pocket tooth #9

The moderate stages of periodontitis are typically characterized by moderate loss of bone (see x-ray below) around the teeth – either vertical or horizontal.  Pockets can measure between 5-7mm, and there may also be associated tissue loss, or gum recession.

x-ray of moderate periodontitis for this patient below:

note the loss of bone between the two front teeth (#9 and #10)

Advanced Periodontal Disease is characterized by more advanced bone loss around the teeth.  There is 50% bone loss or more.  Pockets typically measure 7-9mm or more, and there may or may not be tissue loss (recession of the gums) and mobility.

8mm gum pocket picture below:

this is advanced periodontitis with severe inflammation and mobility – this patient is diabetic -note the profound difference in the tissue appearance from one half to the other.  This patient had already undergone Restorative Periodontal Endoscopy on half his mouth one week prior to taking this picture, the pink healthy tissue on one half is evident in this photo.

x-ray for this patient below:

x-ray of advanced bone loss

There are many advanced case studies with pictures and x-rays throughout this web site to view.  We offer a procedure called Regenerative Periodontal Endoscopy (RPE) - a non-invasive and definitive affordable first phase treatment approach for all stages of periodontal disease.

All  stages of periodontitis – even the advanced stage - may not always be associated with pain, bleeding, or other obvious symptoms and signs.   See more pics. There may be no symptoms at all.  This is why a thorough examination and x-rays by a periodontist (gum disease specialist) or dentist is highly recommended.

Posted in Stages of Periodontal Disease

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The Cost of Periodontal Disease Treatments:

This post will help clarify and define the costs involved in available periodontal treatment options, including Regenerative Periodontal Endoscopy (RPE), Perioscopy, Osseous Periodontal Surgery, Extractions, Implants, traditional laser periodontal therapy, LANAP, and root planing combined with Arestin (antibiotics). Fees may vary depending on location and independent provider.

Below is an example of a treatment plan to replace one front tooth with an implant after the extraction of one tooth.   This is a good example of just how important it is to save natural teeth, rather than undergoing extractions.

• Simple Extraction                             $150
• Tomographic series                           $262
• Implant Placement                          $1900
• Provisional temp. crown                   $250
• Abutment placement                        $500
• Porcelain Crown                               $1000

Total Fees for one implant =         $4062

These fees are fairly typical of what many individuals face to replace one tooth.

In contrast, the cost to save one to eight teeth in a quadrant with Restorative Periodontal Endoscopy is only $600 – $900, depending on the severity of bone loss the number of teeth treated.   View an actual case comparing cost of treating one tooth with Regenerative Periodontal Endoscopy (RPE) instead.

How much do full mouth extractions followed by implants cost? Many of our clients were facing full mouth extractions and were given a $30K - 80K treatment plan by their dentist and periodontist.  This option is certainly definitive and comprehensive, but may not be a good option for everyone.  The devastating implications of full mouth extractions can have an enormous negative impact on a person’s life and self esteem.  While the cost alone is staggering, the enormous time involved with the many follow up appointments, as well as the predictable discomfort, make this a very difficult decision if other viable, less invasive options may be available.  Below is one such example.

Before Regenerative Periodontal Endoscopy (RPE):  5-15mm pockets (advanced periodontal disease)

After RPE – health restored – gen 2-4mm, no extractions or implants necessary.  Read this patients testimonial.

What are the fees for Osseous Periodontal Surgery with or without extractions?

We have treated clients from all over the world faced with 4 quadrants (full mouth) of osseous periodontal surgery.  Fees for this procedure vary depending on how many extractions one needs, as well as bone grafts or regenerative materials are used during the surgery.  Osseous surgery fees can range from $900 – $2200 per quadrant (there are 4 quadrants in the mouth), depending on the number of teeth treated.  This may or may not involve extractions.

If teeth need to be extracted there are additional fees for replacing lost teeth, either with implants, a bridge, or partial dentures.   Fees can add up quickly, easily taking the total for one quadrant (section) to over $5000.

The patient below was facing full mouth osseous surgery:

Before RPE – generized 5-9mm pockets

6 weeks after RPE – health restored - pockets reattached (closed) -  no need for osseous surgery

This patient was facing a $12,000 surgical treatment plan.  By having RPE instead her fees were less than a third of that total.

How much is root planing or “deep cleanings” with local delivery antibiotics such as Arestin?

This non-definitive traditional approach leaves much to be desired in results with advanced cases.   Osseous or flap surgery usually follows this non-definitive approach due to the inability of the clinician to see and remove all the disease causing deposits and plaque on the roots in deep pockets.   Learn the objective truth about the limitations of root planing. Fees for traditional root planing can range from $200 per quadrant to $375 per quadrant (there are usually 4 quadrants). Add to this the fees for Arestin (an antibiotic) placed under the gums during this non-definitive treatment.  Arestin is charged out at $35-$110 per site (one tooth may have several sites), if a patient has multiple deep pockets in one quadrant the fees can add up quickly.  The research is unremarkable, demonstrating a reduction in pocket depths of less than 1mm.   Due to the ineffectiveness of this approach it may be repeated every few months, annually, or every three years.

What is the cost of multiple rounds of traditional laser periodontal therapy?

Typical fees for traditional non-definitive laser periodontal therapy range from $250 – $400 per session (there are usually 6-8 sessions in all). There is very little research demonstrating clinical benefit for this more traditional treatment approach – tartar typically remains in deep periodontal pockets as the literature demonstrates.  Laser periodontal therapy is performed blindly under the gums in an attempt to arrest the disease by “killing bacteria”.  Since tartar in deep pockets and decay may go undetected for months or years,  any benefit of killing bacteria with the laser may be short term.    

What are the fees for LANAP?

After reviewing fees for many offices providing lanap around the country we have determined fees to have a wide range, depending on the severity and the individual clinician offering lanap.  Fees for full mouth lanap treatment range between $4000 to $15,000. The consulation for treatment may cost up to $450.  Lanap is not intended for the treatment of single teeth according to the trained clinicians providing it, therefore only full mouth treatment is performed.

What are the fees for Perioscopy?

Fees for Perioscopy have generally not changed much over the past decade.  Fees can vary somewhat if the office providing perioscopy charges by “time” rather than by quadrant.   In our experience a quadrant fee can be anywhere from $350 to $900.   If antibiotics are used adunctively, such as Arestin or Atridox, additional fees would apply, as well as examination fees; and for many offices traditional root planing fees are charged prior to the actual perioscopy treatment.

What are the fees for Regenerative Periodontal Endoscopy – RPE?

Regenerative Periodontal Endoscopy – RPE can prevent steep costs by eliminating or reducing the need for extractions, traditional flap surgery, osseous surgery,  repetative treatment with perioscopy or traditional root planing, and laser periodontal surgery.

Fees for RPE can range from $600 per quadrant to $900 per quadrant (there are 4 quadrants if all teeth are present).  Fees for full mouth RPE treatment can range from $2400 to $3600, depending on the severity of disease and the number of teeth treated.  There are no fees for the examination or any records needed.  RPE is performed in one appointment and local anesthetic is used for comfort.  One tooth can be treated with this modality (rather than requiring full mouth treatment as with LANAP), fees for one tooth can be $450-$600, depending on the severity.  No traditional root planing is recommended before RPE.

Watch a short video to see how this pioneering treatment works.

We offer complimentary periodontal consultations .  Contact us for more information.

Posted in Cost of Periodontal Treatments

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Gum Disease Now Linked to Dementia: 

In addition to the overwhelming evidence to support the theory that periodontal disease contibutes to cancer, heart disease, stroke, diabetes, and pre-mature births, there are now studies to support a link between periodontal disease and dementia. All countries are experiencing an increase in the number of people over the age of 65 with Alzheimers.  Alzheimer’s disease is the leading cause of dementia in the US population.

A study of dementia led by University of South California researchers revealed that missing teeth and chronic inflammation of the mouth at an early age quadruples the risk of developing Alzheimer’s disease. The study, which was presented at the first Alzheimer’s Association International Conference on Prevention of Dementia, looked at the records of over a hundred pairs of identical twins.  Each pair consisted of one twin who had developed dementia, and one who had not. Acting on the principle that identical twins share the same genetic blueprint, the study looked into external factors that could have led to the mental demise of the demented twin.

Dementia is an umbrella term that includes Alzheimer’s disease, and once correctly diagnosed in the twins examined, researchers looked into several potentially modifiable risk factors that could have brought it on.  Among these were: periodontal disease before age 35, the experience of a stroke before the onset of dementia, physical exercise between ages 25-50 and years of education.

Titled Potentially Modifiable Risk Factors From Dementia: Evidence from Identical Twins, the study found that a stroke could increase the risk of dementia six-fold in later years, while periodontal disease in early years quadruples that risk.

Lead author Margaret Gatz said the link between periodontal disease and Alzheimer’s does not mean that extra flossing will defend against dementia, adding that catchphrases like “Brush your teeth: Prevent Alzheimer’s disease,” are excessively naive.  Periodontal disease should instead be seen as an indication of exposure to inflammation, which in turn can proceed to harm brain tissue and cause dementia, Gatz said.

Learn more about our advanced gum disease treatment to end chronic periodontal inflammation

For more information about Alzheimer’s:

http://www.hsibaltimore.com/ealerts/ea200709/ea20070918a.html

http://www.eurekalert.org/pub_releases/2005-06/uosc-adl061605.php

https://www.nyu.edu/dental/news/index.html?news=127

Other health risks associated with periodontal disease

Definitive treatment for periodontal disease involves a multi-faceted approach to control chronic inflammation.  Putting periodontal disease into remission and ending the chronic inflammation associated with it is not achieved by merely removing tartar, the repetative use of antibiotics (either locally or systemically), or cutting out pockets with a laser or traditional periodontal surgery.  Chronic hyper-inflammation is a host response problem and may require the addition of safe and effective anti-inflammatory medications.

Posted in Alzheimer's and Periodontal Disease

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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 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.  Enzyme inhibitors are used to promote more rapid healing and stability of the gums. 

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:

  
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,  impant, and crown.

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

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

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

           
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.

    
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.

(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.    

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

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

 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

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

     tongue stud damage                                                  6 months after RPE – health restored

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

Before 11mm pockets                                          bone fill at 6 months

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

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

     Before RPE                                       6 weeks after - good bone fill occuring

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

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

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

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

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

       
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 stratagies – 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 tendancy 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 independantly, 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 multifactoral, 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 go to host modulated therapy.

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

Tags: Case Studies
Posted in Case Studies | How RPE Works

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

 
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. 

 
3 months after RPE – 4mm – very healthy tissue – no bleeding.  He chose to have affordable Regenerative Periodontal Endsocopy, RPE, and has remained stable and healthy for many years.  This patient has not lost a single tooth.   Learn more about this unique protocol.

 
Before RPE - 9mm infected advanced periodontal pocket- tooth #8 is very loose

 
After RPE – 2mm, healthy, no bleeding, no mobility.

 
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 chose 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 in an attempt to reduce periodontal pockets, and in doing so the roots are exposed causing disfigurement of the gums.  

 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 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 the laser and 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.  Since there is no trauma to the tissue, the disfigurement and recession often associated with traditional periodontal surgery does not occur with RPE.

Tags: Case Studies
Posted in Advanced Periodontal Disease Pictures

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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

Tags: cancer, periodontal disease
Posted in Cancer and Periodontal Disease | Case Studies

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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 (Images provided by DentalView, Inc. – taken by Gayle Meyers, RDH and Roger Stambaugh, DDS – leaders of periodontal endsocope technology use and research).

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”.

Note:   We would like to thank Gayle Meyers, RDH and Roger Stambaugh, DDS for their pioneering work in perio-endoscopy over the years, and for providing the above information.  We would also like to thank these leading periodontists and supporters of this technology: Dr. Mellonig, Dr. Tom Wilson, Dr. Mike Rethman, and Dr. Ben Jacoby.

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.

Tags: how to, Perioscopy, tools
Posted in Perioscopy

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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

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:

- 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.

Posted in Bone Regeneration | Case Studies

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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.  One could describe it as an “allergy”. For these individuals plaque bacteria causes inflammation on contact, triggering the immune system to go into hyper-drive, leading to periodontal destruction.  This hyper-inflammatory response creates an over-production of harmful enzymes, allowing chronic periodontal destruction to ensue.  It’s important to realize, however, that this genetic variant will actually create periodontal destruction, even in the abscence of, or in the presence of minimal amounts of bacterial plaque.  

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

The PST Genetic Test 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 PST Genetic Test assists a clinician in creating a personalized treatment plan. The information gained from this test can be useful for all dental professionals and their patients.

The PST Genetic Test detects specific variations in the interleukin-1A and interleukin-1B genes. The presence of these variations (a PST-positive result) increases the risk for periodontal disease 3 to 7-fold and for tooth loss 3-fold. The combination of a PST-positive test result and smoking leads to an even greater likelihood for severe periodontal disease and early tooth loss.

Important information about genetic “exaggerated immune response” your dentist probably doesn’t know and/or hasn’t told you:

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

According to Carranza in the 9^th 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

The good news is that advanced technologies will now allow us to alter the usually predictably poor outcome of genetic periodontal disease.  These individuals are typically blamed for having poor home care, which is not always true.  Host factors, such as genetics, must be addressed 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 many individuals.  A synergistic approach must be incorporated involving addressing the hyper-inflammatory response.

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 (four fold), 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.

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

Tags: genetics, periodontal disease
Posted in Perio Disease - Genetics

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Host Modulated Therapy

Sub-antimicrobial dose doxycycline 20mg (SDD), also called PerioStat, is an effective way to therapeutically control, or “down-regulate” exaggerated levels of harmful enzymes associated with chronic periodontal disease destruction (gum and bone loss around the teeth).  This post will help clarify the adjunctive benefit of SDD (sub-antimicrobial dose doxycycline) as an important part of our protocol called RPE, or Regenerative Periodontal Endoscopy.

Periodontal research has revealed that the body’s exaggerated inflammatory response to bacteria is what causes periodontal destruction in many individuals.  Once thought to only be helpful, we now know that inflammation can actually be very harmful especially the chronic inflammation associated with periodontal disease. Periodontal research published on SDD (low dose doxycycline – PerioStat) demonstrates that SDD is an excellent adjunct to periodontal therapy – reducing chronic inflammation and arresting or slowing bone bone loss.  Periodontal inflammation can be controlled with SDD while all risk factors (host factors) contributing to chronic inflammation are uncovered and defintively addressed. 

Down regulating chronic inflammation with host modulation (SDD), starting one week before performing the microscope procedure called RPE reduces bleeding and inflammation significantly, allowing excellent vision in all periodontal pockets.   Down regulating the chronic inflammation process with host modulation prior to treatment  firms all gum tissues, allowing more rapid healing (reattachment and regeneration) following RPE.  

Host factors contributing to chronic periodontal inflammation may include genetic predisposition (exaggerated host response), smoking, diabetes and prediabetes (elevated glucose levels), obesity, AIDS or other immune diseases,  neglect, inadequate professional cleanings, depression and medications for depression, depleted or excess hormones including thyroid, poor diet, vitamin deficiencies, dry mouth (xerostomea), alcoholism, medications for high blood pressure (calcium channel blockers), and stress.

More about risk factors in periodontal disease:  www.umm.edu

Sub-antimicrobial dose doxycycline (SDD) 20mg tablet, taken up to twice daily, slows the progression of periodontal disease by suppressing or down-regulating the “over-production” of a destructive enzyme called collagenase.   At only 20mg, this low dose of doxycycline puts the body back into balance by reducing inflammation and allowing periodontal health to be restored when combined with active periodontal therapy (professional care).  If  used with periodontal endoscopy and emdogain (RPE), SDD can actually enhance and promote regeneration - Regenerative Periodontal Endoscopy -RPE.    

Important note about SDD:  At this very low dose, 20mg doxycycline is sub-clinical (sub-antimicrobial dose), meaning it has no effect on the bacteria whatsoever. The therapeutic benefit of this medication has nothing to do with killing bacteria anywhere in the body.  In addition, research demonstrates that there has been no evidence of antibacterial resistance using SDD, even long term (12 months).

Suggested important reading on SDD:  “Host reponse modulation in Periodontics” – by Philip Preshaw, DDS, MS, Periodontology 2000, Volume 48, 2008, 92-110. 

            -exerpts from the above paper below - 

 Certain individuals appear to be more susceptible to periodontal disease, and this increased susceptibility is largely determined by the immune-inflammatory response that develops in the periodontal tissues following chronic exposure to bacterial plaque. Periodontal pathogenesis has been extensively reviewed by a number of authors (52, 54, 73) and it is not the purpose of this paper to cover this ground again. Suffice to say, the microbial challenge presented by subgingival plaque results in an upregulated host immune-inflammatory response in the periodontal tissues that is characterized by the excessive production of inflammatory cytokines (e.g. interleukins, tumor necrosis factor- (e.g. prostaglandin E matrix metalloproteinases (MMPs)]. These proinflammatory mediators are responsible for the majority of periodontal breakdown that occurs, leading to the clinical signs and symptoms of disease.

  Effects of low dose doxycycline (SDD)  

• Direct inhibition of active MMPs by cation chelation (dependent on Ca2+- and Zn2+-binding properties)

• Inhibits oxidative activation of latent MMPs (independent of cation-binding properties)

• Downregulates expression of key inflammatory cytokines (interleukin-1, interleukin-6 and tumor

necrosis factor-a) and prostaglandin E2

• Scavenges and inhibits production of reactive oxygen species produced by neutrophils

• Inhibits MMPs and reactive oxygen species thereby protecting a1-proteinase inhibitor, and thus

indirectly reducing tissue proteinase activity 

 • Stimulates fibroblast collagen production (stimulates regeneration of collagen)

• Reduces osteoclast activity and bone resorption

• Inhibits osteoclast MMPs

Clearly, SDD has regenerative benefits as chronic inflammation subsides.  Thus, it is one of the most valuable tools available in the fight against periodontal disease, especially if there are systemic host factors which cannot be controlled such as a genetic hyper-inflammatory immune response. 

Published research also demonstrates that added benefits of taking SDD daily include keeping blood glucose levels normalized,  lowering CRP (C-Reactive Protein) and other biomarkers for cardiovascular disease, and lowering cholesterol in patients with chronic periodontitis and cornonary artery disease.  This is profound, and demonstrates well that SDD has a positive effect throughout the body.  SDD is also effective in the treatment of rosacea and rheumatoid arthritis. 

Preventative periodontal care is about helping our patients to understand what is causing their disease, discussing options for treatment, and reasonably predicting long term outcomes.  There are host factors (risk factors) which cannot be controlled with all the best intentions – such as genetic predisposition – without modifying the host response.  SDD is an excellent and effective adjunct to alter the course of periodontal disease safely and effectively.

Note:  SDD requires a prescription and is available in generic form to reduce the expense.  Generic doxycycline 20mg is avialable in most drug stores.   The brand name of SDD is PerioStat. 

Excerpts from the Journal of Clinical Periodontology 2004 Sept. re SDD:

Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis. A review.

Preshaw PM, Hefti AF, Jepsen S, Etienne D, Walker C, Bradshaw MH.

School of Dental Sciences, University of Newcastle upon Tyne, UK.

Studies have shown that SDD, when prescribed as an adjunct to scaling and root planing (SRP), results in statistically and clinically significant gains in clinical attachment levels and reductions in probing depths over and above those that are achieved by SRP alone. SRP must be thorough and performed to the highest standard to maximise the benefits of adjunctive SDD.

SDD does not result in antibacterial effects, or lead to the development of resistant strains or the acquisition of multiantibiotic resistance. The frequency of adverse events is low, and does not differ significantly from placebo.

Articles about sub-antimicrobial dose doxycycline (SDD):

http://uuhsc.utah.edu/pharmacy/bulletins/doxycycline.html

http://www.umm.edu/patiented/articles/how_antibiotics_being_used_long-term_prevention_of_periodontal_disease_000024_9.htm

http://www.natural-hrt.com/artman/publish/article_133.shtml

http://ezinearticles.com/?Low-Dose-Doxycycline-Therapy&id=552971

What about more published research with sub-antimicrobial dose doxycycline?  There are numerous papers published on SDD demonstrating the therapeutic benefits in the treatment of periodontal disease.  Click on the links below and browse through additional links there.

http://www.ncbi.nlm.nih.gov/pubmed/15766366?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

Learn more about all natural Periogain as an option for host modulation for those individuals who cannot or will not take Periostat, or who would rather have a more natural approach.

Posted in Host Modulated Therapy | Periostat (Sub-antimicrobial dose doxycycline)

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