Alternative Periodontal Disease Treatment Options for Deep Gum Pockets

Alternative Gum Disease Treatment Options for Deep Gum Pockets

This post will define the available professional “alternative gum disease treatment options” for deep gum pockets.  

When traditional therapies such as root planing (deep cleaning) with antibiotics, or basic laser periodontal therapy are exhausted, the next indicated step for a more definitive treatment to stop infection in unresponsive deep pockets may be traditional periodontal surgery.  However, many individuals decide to seek alternatives to traditional periodontal surgery for the following reasons in our experience:  to avoid pain and long term tooth sensitivity, to prevent large gaps or black triangles between the teeth, to avoid recession of the gums following surgery, to avoid extractions of teeth deemed hopeless,  and to avoid the potentially huge costs associated with periodontal surgery and tooth replacement. 

The following periodontal treatment options are at this time considered to be alternatives to traditional periodontal surgery.

Regenerative Periodontal Endoscopy℠ – Non invasive procedure to promote closure of deep gum pockets and repair bony defects.

This non-invasive procedure employs the use of a periodontal endoscope.  RPE℠ differs from a standard perioscopy procedure in many ways.  The inclusion of enzyme inhibitors and regenerative proteins to promote reattachment of pockets and bone fill.  In addition, RPE℠ is performed with very precise and efficient tools (piezo diamond tips), which allows skilled clinicians to complete the procedure more efficiently while preventing root damage and tissue trauma from occurring.   An occlusal adjustment is often performed to aid in overall healing. Teeth deemed hopeless can be treated with RPE℠ as an alternative to extractions due to the non-invasive nature of the procedure.

before RPE℠ After RPE℠ JPeg

Before RPE℠  – deep gum pockets/bone loss           After RPE℠ – reattachment of gum pockets/bone fill

See case studies (actual patients of PerioPeak Innovations)

Perioscopy – visual removal of tartar in deep pockets only

This non-invasive procedure employs the use of a dental endoscope to “see” microscopically into deep periodontal pockets. This allows the clinician to better remove the tartar and plaque (biofilm) from the roots which have already been root planed blindly without success.   It is simply “visually enhanced root planing” (removing tartar from pockets).  Local anesthetic is used.   The tools used to actually remove the root deposits (tartar) vary widely from clinician to clinician, as well as the actual proficiency and skill.   Results and long term results will vary due to skill level, experience, and technique.  This procedure may include adjunctive therapies such as antibiotics, either placed beneath the gums or given systemically.  While there is some impressive published research to support perioscopy, it has still not been embraced by the main stream dental profession as a viable treatment option for periodontal disease.  In some offices perioscopy is only employed when all other methods have been exhausted rather than utilizing it as a first phase treatment approach. 

Explorer In Hand ScalerTipOnCalculus

Perioscope in hand (miniature fiber optic)   –   48X magnification on a 10,000 pixel color monitor allows for real time pinpoint tartar removal in deep gum pockets.


PerioProtect – a non-definitive approach for first phase treatment, but an impressive maintenance program if necessary.

PerioProtect is a relatively new treatment non-definitive option for patients with unresolved periodontal infections and periodontal pockets.  This professional treatment involves having a custom mouth tray fabricated by the dentist  for the patient to use at home.  These trays are then filled with antibiotics, or antimicrobials such as hydrogen peroxide (depending on the need), and are worn several times a day, up to several hours a day.  PerioProtect is  intended to be an adjunctive therapy with traditional root planing and periodontal maintenance cleanings.  No surgery is performed to correct pockets and no dental endoscope is employed to aid in the removal of tartarand biofilm from deep gum pockets, therefore periodontal infections and gum pockets may continue to be a chronic problem. PerioProtect trays are supposed to kill bacteria in deep pockets, but the depth that the medicament will reach remains questionable due to lack of research.  The company has gone to great lengths to market their product but to date have only demonstrated their medicament reaching one pocket of 6mm.  Tartar trapped under the gum in deep pockets is not removed by this product, therefore results may be temporary.

Traditional and Alternative Treatment Options to Reduce Deep Gum Pockets

Periodontal Disease Treatment Options for Treating Deep Gum Pockets

It is important to consider all options very carefully and to find what actually works well long term (results as demonstrated by real case studies and published research).  In addition, it is also important to consider how a particular treatment fits into overall goals, expected outcomes, lifestyle, convenience, comfort, and budget.    Knowledge is empowering, we encourage all periodontal sufferers researching periodontal treatment options to consider all this information carefully.

Regenerative Periodontal Endoscopy- RPE℠

This advanced endoscopic procedure eliminates cutting the gums open. Instead, reattachment of the pockets are promoted with microscopic removal of calculus and the addition of regenerative protiens and systemic enzyme inhibitors.  RPE℠ may eliminate the need for aggressive periodontal surgery and/or extractions, but we encourage all patients to consider close monitoring by a periodontist throughout their life if they have a history of chronic periodontal problems.  RPE℠ is completed in one appointment and local anesthetic is used for comfort.

Gum gaps are minimized, or not created, following RPE℠ as with traditional periodontal surgery.


6 weeks following RPE℠ – a nice esthetic result, health restored.

contact us for more information about RPE℠

Root Planing (deep scaling):

Root planing is still the “standard of care’ for the initial phase in treating all stages of periodontal disease, yet it is a non definitive, blind treatment approach.  The literature does not support this traditional approach in the advanced stages of periodontal disease –  it is usually followed by periodontal surgery due to the visual and clinical limitations. Root planing, or deep cleaning, is generally performed with local anesthetic (Novocaine), and is usually completed by sections, or quadrants.  The clinician performing this treatment employs the use of either standard aggressive scaling tools (curettes), or an ultrasonic scaling device, or both.  The goal of this procedure is to remove as much tartar and plaque from the roots below the gum line as possible by tactile means (blindly).  The deeper the pockets, the more challenging.   Sometimes roots can be damaged by “over-planing”, or over-scaling.   In addition, many studies over decades show that gum pockets with a depth over 4mm may have up to 30-50% of the calculus (tartar) left behind following traditional root planing.

Picture2 5 Perioscopy after SRP

Before root planing (deep cleaning)             After root planing (up to 50% of tartar left on root)

Below is a list of adjunctive therapy options used with root planing in an attempt to obtain a better result:

1) Soft Tissue Lasers – many clinicians may employ the use one of two types of lasers to eliminate plaque bacteria in and around the roots while performing root planing.  The problem with this technique is that it is performed by feel (tactile means), therefore infectious tartar remains trapped in deep gum pockets.  Multiple treatments are usually recommended, adding to the overall cost and inconvenience.  In addition, the literature has demonstrated little to no benefit for this technique.  The cost vs. value may not be justified.

2) Local Delivery Antimicrobials – there is a variety of different adjunctive products called LDA’s (local delivery antimicrobials) which a clinician can employ in an attempt to enhance the result of root planing.  The idea is to root plane as well as possible (no objective end point), then place an LDA into the pocket.  The available LDA’s are Arestin, Atridox, Perio Chip, and Actisite.  The idea of all of these products is to kill bacteria in the deeper periodontal pockets.  However, the research on all of these adjunctive therapies remains unimpressive.  Results are typically temporary and cost vs. value may not be justified.

3)  Periowave – not yet available in the U.S. (still in the FDA approval stage), Periowave utilizes a non-thermal laser light combined with a photosensitizing solution designed to kill bacteria associated with gum disease when used adjunctively with root planing.  As with any of these adjunctive therapies, this technique is non-definitive and the literature is not impressive.  No endoscope is employed;  therefore tartar may remain in deep pockets.

Periodontal Surgery (Osseous, Flap, and Regenerative):

Following root planing, and the various adjunctive therapies listed above, periodontal surgery may be recommended in an attempt to eliminate periodontal pockets.   Periodontal surgery is performed in sections, or quadrants, under local anesthetic and often with the addition of oral sedation or nitrous oxide.  There are three types of periodontal surgery aimed at eliminating periodontal pockets and arresting periodontal disease.

Picture3 Picture4

pictures of periodontal surgeries described below – note the tartar on the roots following traditional root planing

Osseous periodontal surgery – gums are pealed back using a scalpel and other surgical instruments, tartar is then removed from the roots with an ultrasonic and a drill.  The bone around the teeth is then contoured with a drill as uneven bone is removed, hence the term osseous surgery.  The extra gum tissue is cut away (gums are removed as pockets are cut out).   This is also called “pocket reduction” surgery.  The gums are then sutured around the teeth in a lower position on the roots, creating recession and black triangles (gaps between the teeth).   This procedure is very aggressive, and while it works well to “eliminate periodontal pockets”, it leaves much to be desired in aesthetics, patient comfort, post operative root sensitivity, cost, inconvenience with multiple appointments, and long term results.  Research even demonstrates that in some cases patients will lose bone more rapidly following this surgery than if they had not had surgery.  Since large gaps called “black triangles” are often the result of this surgery, (as well as gum recession and long term root sensitivity), one should take caution if exploring this option.


Above: Gaps, recession, and long tooth appearance as a result of osseous periodontal surgery.

Note: the same result can be seen with “pocket reduction surgery” or flap periodontal surgery.

Flap periodontal surgery – flap surgery follows root planing to allow for more complete removal of tartar from the roots, especially in deeper pockets and tricky root morphology (furcations).  This procedure is explicitly for the purpose of removing tartar left behind following traditional root planing and is not intended for recontouring the bone or promoting regeneration of any kind.  The gums may or may not be “cut away” before sutering, in an attempt to reduce periodontal pockets to a level which can more easily be maintained (cleansed) by the patient.  It is important to note that any type of gum surgery creates scar tissue, as well as recession of the gums.   The literature does not support this technique over traditional root planing for long term results and efficacy, and according to one study can actually make the condition worse, accelerating bone loss.  One should take caution if exploring this option for treatment of any of the anterior teeth (front teeth) due to the possible negative impact on appearance (aesthetics).

Minimally Invasive Regenerative Periodontal Surgery, or MIST:   by far the most impressive type of surgery for the treatment of periodontal disease.  This surgery is very similar to osseous surgery, with the added benefit of placing regenerative materials.  The regeneration material used varies based on the type of periodontal defects present, and the clinicians knowledge and experience using a particular regeneration material.  The main regeneration proteins used are Emdogain and Gem 21.  We highly recommend Dr. Tom Wilson or Dr. Steve Harrel in Dallas, Tx.

Diabetes and Periodontal Disease

How is diabetes, or prediabetes, related to periodontal (gum) diseases?

One of the main risk factors for the development of periodontal disease is diabetes.   We now know that individuals with type II diabetes are three times more likely to develop periodontal disease.   Conversely, results from the National Health and Nutrition Examination Survey (NHANES) and its follow-up studies suggest that non-diabetic adults with periodontal disease develop type 2 diabetes more often than those without periodontal disease.

In 2003 the American Diabetes Association stated that periodontal disease is often found in people with diabetes.  However, there are millions of individuals who are unaware that they may be “prediabetic” (they have elevated blood sugar levels), and that this may be a contributing factor in their periodontal disease.   While diabetes and pre-diabetes occur in people of all ages and races, some groups have a higher risk for developing the disease than others.   Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.  This means they are also at increased risk for developing pre-diabetes.

What we now understand about diabetes and periodontal disease is that an elevation in inflammatory mediators in the gums is the cause for the close association between diabetes and increased incidence of periodontal diseases .  Bacteria thrive in the individual with elevated blood glucose, stimulating pro-inflammatory mediators, which leads to an overproduction of a bone destroying enzyme called collagenase.  It is well established that elevated levels of collagenase lead to the destruction of the periodontal ligament and bone supporting the teeth.

What you can do:

1) Get Tested

We highly recommend an HbA1c blood test for an accurate assessment of average glucose levels over time.  In our experience the simple fasting glucose test is not a good indicator of borderline or current diabetes.

Go to for more information

2) Learn More

A great comprehensive paper by water pik on diabetes

The two way connection

“Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.  Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.”  (American Academy of Periodontology)

Go to for more information abou the “mouth-body” connection, there are numerous articles on this topic.

3) Get definitive periodontal treatment

4)  Look into adjunctive medication which can help. How to help control chronic inflammation and destructive levels of collagenase enzymes created by elevated glucose levels and lack of good glycemic control.

Also Important to consider:

Prevention and proactive treatment of periodontal disease is fundamentally important in patients with diabetes because of the potential negative impact of untreated periodontitis on glycemic control and diabetic complications.  But as we have observed, one disease ‘feeds’ the other.  Addressing this two way connection is crucial to achieving periodontal health.  Host factors contributing to both periodontal disease and glycemic control must be defintively addressed if we are to expect success and remission of both diseases.

At PerioPeak Innovations we pinpoint and address all risk factors which may be contributing to your periodontal disease.  We pride ourselves in finding the cause – rather than just treating the effect.  Our mission is to provide comprehensive periodontal care,  empowering all of our clients for long term periodontal and overall health.

Find out how our advanced non-surgical approach for chronic periodontal disease can help to maintain optimal health.

Further important considerations with diabetes, periodontal disease, and cardiovascular disease:

Below is an exerpt from J. Periodontal 7/09 – The American Journal of Cardiology and Journal of Periodontology Editor’s Concensus:  Periodontitis and Artherosclerotic Cardiovascular Disease.

Metabolic Syndrome

Metabolic syndrome is diagnosed when 3 of the following features are present: (1) increased waist circumference(men ‡40 in [‡102 cm], women ‡35 in [‡88 cm]), (2) increased serum triglyceride level (150 mg/dl [1.7 mmol/L]) and/or drug treatment for elevated triglycerides (most commonly fibrates and nicotinic acid), (3) decreased serum HDL cholesterol level (men <40 mg/dl [1.03mmol/L], women <50 mg/dl [1.3 mmol/L]) and/or drug treatment for decreased serum HDL cholesterol, (4) elevated blood pressure (‡130mmHg systolic and/or ‡85mmHg diastolic) or antihypertensive drug treatment of patients with histories of hypertension, and (5) elevated fasting glucose (blood glucose ‡100 mg/dl) and/or drug treatment for hyperglycemia.


Patients with periodontitis meeting criteria for metabolic syndrome should be identified, and all risk factors for atherosclerotic CVD should be treated, beginning with lifestyle changes aimed at weight reduction. Metabolic syndrome is closely linked to insulin resistance and is a secondary target of lipid therapy because the risk factors for metabolic syndromeare highly concordant and, in aggregate, enhance the risk for atherosclerotic CVD at any serum level of LDL cholesterol.

Many patients with periodontitis meet criteria for the metabolic syndrome.  Because measures of systemic inflammation are a common feature of periodontitis and metabolic syndrome, it may be particularly important to identify patients who meet these criteria for CVD prevention strategies.  We highly recommend The Bale Doneen approach to early diagnosis, intervention, and prevention.

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Signs and Symptoms of Gum Diseases

How do I know if I have some form of gum disease?

Gum disease, also known as periodontal disease, is a chronic inflammatory and infectious disease. Often there may not be signs or symptoms until the disease is well into the advanced stages unless you are routinely examined by a dentist.  Below is a list of all possible, more acute symptoms of moderate to advanced periodontal or gum disease.

1)  Halitosis (bad breath)

2)  Loose teeth, bite changes

3)  bleeding gums

4)  painful gums

5)  puffy, red gums

6)  pain when chewing

7)  pussy discharge from the gums

8)  gums pulling away from teeth (gum recession) and noticeably longer teeth.

9)  bad taste

10) noticeable gaps between teeth (“black triangle” appearance)

This picture is a good example of a patient in the advanced stages of periodontal disease.  Note the gum recession and “black triangles” between the teeth, as well as the puffy, bleeding gums. 

Find out how periodontal (gum) disease can be effectively treated with Regenerative Periodontal Endoscopy℠, or RPE℠.  

Some less obvious symptoms and signs of periodontal disease in the moderate to advanced stages may be chronic fatigue, swelling of the lymph nodes, or the inability to control blood sugar levels in individuals with diabetes.   Since periodontal disease is a chronic inflammatory disease, it takes a tremendous amount of energy for the body to “control it”.  The immune system is constantly being taxed in an effort to rid the body of infection.   The bacteria involved in periodontal diseases are pathogenic, meaning they are harmful to the body, causing infection.

While periodontal disease is characterized by a chronic infection leading to chronic inflammation in some, it is the actual inflammatory process (an upregulated or exaggerated inflammatory response) which leads to more advanced bone and tissue loss around the teeth.  The body is so efficient at ridding itself of this infection  -for survival purposes – that the infection/inflammation process will often continue if no professional treatment is pursued, until the affected tooth is extruded by the body (the tooth falls out).

New research is proving that the old model of “infection leading to chronic inflammation” may actually be the other way around in many individuals.  Chronic hyper-inflammatory response ( “hyper-responder”) in many susceptible individuals may actually lead to a chronic infections.

These individuals are prone to inflammatory periodontal disease.  Traditional approaches will not generally stop the infection, especially long term.  Read more about genetic tendencies.

To determine if you have periodontal disease we highly recommend a professional examination, including full mouth x-rays and periodontal charting, by a gum specialist, or periodontist.  These professionals have many years of specialized training beyond dental school and are able to reach a more accurate diagnosis.   If you have been “maintaining” your chronic periodontal disease (infection) in a general dental practice with maintenance cleanings, and you have the moderate to advanced stages of gum disease, it is imperative to seek more specialized professional help.

Lack of proper diagnosis and definitive intervention of periodontal disease can lead to serious, even life threatening, and very expensive health problems as we now know.  But the millions of dollars spent “replacing teeth lost to periodontitis” is often overlooked.

Below is a picture of extractions from a single day in a periodontal specialty practice:

All of the individuals who lost these teeth had routine dental cleanings and maintenance in a general dental practice.  The cause of tooth loss is multi factorial, but nearly all of this is preventable with more advanced technology and intervention.

This blog is filled with detailed information as to what causes tooth loss and the limitations of main stream approaches to arresting or curing periodontal diseases.  We encourage you to explore all of this objective information.

See pictures and read about the limitations of traditional root planing

Read about genetics and periodontal disease


Maintaining Optimal Periodontal Health

How to Maintain Optimal Periodontal Health

Regenerative Periodontal Endoscopy℠ – RPE℠, helps to repair the periodontal foundation and sets the stage for improved periodontal health by eliminating microscopic calculus (tartar) and bacteria deep below the gumline, removing infected tissue, and stimulating attachment repair with natural proteins.  How to maintain this level of health long term is the subject of this post.  We strive to empower periodontal sufferers through education.  There are several aspects to be considered, including excellent home care, regular professional cleanings, addressing bite problems, smoking cessation, considering anti-inflammatory medications when necessary, having good blood sugar control (nutrition), reducing stress, and promoting overall general health and wellness.

Home Care:

Excellent self care (home care) is of course very important if optimal periodontal health is to be maintained.  It has been our experience that once the chronic inflammation and destruction are addressed with RPE℠, maintaining excellent periodontal health becomes much easier.   We highly recommend the water pik and an Oral-B sonic toothbrush for general self cleansing.  We have found this combination of home care tools to be most beneficial for daily removal of biofilm more effectively.

Recently, an innovative product which claims to dissolve calculus (tarter) below the gumline has captured our attention.   This product, called Periogen by Global Tonic, is an easy to use powder dissolved in water.  Periogen is used with a water pik and/or an irrigator for deeper pockets.  While this may be a tremendous breakthrough, these claims have not been substantiated yet with studies.  However, it has been our experience that regular use of this product “seems to” change the nature of the calculus, making it easier to remove during maintenance cleanings.   Again, this has not been proven with research and is merely anecdotal information. While Periogen may have benefit in loosening or dissolving some calculus between cleanings it may also be helpful in keeping areas clean and healthy which may be more challanging for any type of periodontal treatment to help repair, ie, advanced furcations (advanced bone loss between roots), which may be considered to have a poor prognosis long term.

It is important to note that using any irrigation product, or home care aid, will not definitively address the very serious nature of the periodontal disease process alone.  Periodontal disease is a multifactoral medical condition and requires a very comprehensive, multifaceted, and definitive professional treatment approach. 

For more information for any of these products check out these links:

Host response modulation: 

For many individuals good home care along will not be enough to maintain optimal periodontal health.   Genetic tendancies will often dictate the progression of periodontal disease.  We now know that 1/3 of the population have a genetic tendancy to develop advanced periodontal disease through no fault of their own.  This can be described as an allergy, or “hyper-inflammatory” response to plaque bacteria.  In the literature these individuals are referred to as “hyper-responders”, with an immune system that actually up-regulates itself even in the presence of very little plaque bacteria.  A lot of research is being conducted in this area of periodontal pathogenesis and how to address it.  Periodontal specialists are now discovering the need for more proactive and aggressive treatment of these individuals including the use of “host modulated therapy”.  The most successful form of host modulated therapy is the addition of a medication called PerioStat, also known as SDD (sub-antimicrobial dose doxycycline 20mg), for the purpose of addressing the hyper-inflammatory mechanisms internally.   Few individuals may not be able to tolerate this medication either due to allergy or side effects, this is rare.  Others may not be able to get the prescription necessary to obtain this effective medication.  Unfortunately, few dental professionals are educated in it’s therapeutic use.

Recently at PerioPeak, a natural approach fora type of host modulated therapy has been discovered.  We feel this is a very exciting breakthrough to help chronic and destructive gum inflammation.  To learn more about this natural alternative go to

Learn more about genetic periodontal disease and host modulated therapy

Nutrition and Supplementation:

One important host factor for healthy gums, which can be controlled by the individual, is diet and nutrition.  We have uncovered numerous research papers supporting this statement.  A diet high in antioxidants and natural anti-inflammatories, and low in refined carbohydrates, is a good start. 

We also highly recommend supplementation with these key vitamins for improved periodontal and overall health:  Vitamins B12,C, D, E, Magnesium, Calcium, Co-enzyme Q10, and Omega three fatty acids.  We recommend a comprehensive physical examination once a year with a physician or naturopath to determine nutritional needs, and to identify any health concerns which could be contributing to periodontal disease.

Stages of Periodontal Disease – Pictures and X-rays


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.

gary retracted

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 8.9

x-ray demonstrating early periodontal stage periodontal bone loss

Moderate Periodontal Disease: below

7D 6mm

6mm gum pocket on tooth #7

9D probing

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:

x-ray #9

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:

25m 8mm

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:

8mm 25M x-ray

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.


The Cost of Periodontal Disease (Gum Disease) Treatments

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  (this fee does not include bone grafting or sinus lift)

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 Regenerative Periodontal Endoscopy is only $750 – $1000, depending on the severity of bone loss and 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 $230 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 consultation 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 (just cleaning of the roots) has 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 adjunctively, 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,  repetitive treatment with perioscopy, traditional root planing, or laser periodontal surgery.

Fees for RPE℠ can range from $750 per quadrant to $1000 per quadrant (there are 4 quadrants if all teeth are present).  Full mouth RPE℠ treatment can range from $3000 to $4000, depending on the severity of disease and the number of teeth treated.  There are no fees for the examination or digital records.  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 $750-$900, 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.

Alzheimer’s and Periodontal Disease – Update on link

Gum Disease Now Linked to Dementia: 

All countries are experiencing an increase in the number of people over the age of 65 with Alzheimer’s.  Alzheimer’s disease is the leading cause of dementia in the US population. Current studies demonstrate a definitive link between the presence of periodontal pathogens and the inflammatory burden and oxidative stress observed in the brain’s of individuals with Alzheimer’s.

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.

Effective periodontal treatment is now considered a modifiable risk factor for Alzheimer’s – new information about periodontal pathogens and Alzheimer’s:

Rev Assoc Med Bras. 2014 Mar-Apr;60(2):173-80.
Alzheimer’s disease and periodontitis–an elusive link.
Gurav AN.
Author information
Alzheimer’s disease is the preeminent cause and commonest form of dementia. It is clinically characterized by a progressive descent in the cognitive function, which commences with deterioration in memory. The exact etiology and pathophysiologic mechanism of Alzheimer’s disease is still not fully understood. However it is hypothesized that, neuroinflammation plays a critical role in the pathogenesis of Alzheimer’s disease. Alzheimer’s disease is marked by salient inflammatory features, characterized by microglial activation and escalation in the levels of pro-inflammatory cytokines in the affected regions. Studies have suggested a probable role of systemic infection conducing to inflammatory status of the central nervous system. Periodontitis is common oral infection affiliated with gram negative, anaerobic bacteria, capable of orchestrating localized and systemic infections in the subject. Periodontitis is known to elicit a “low grade systemic inflammation” by release of pro-inflammatory cytokines into systemic circulation. This review elucidates the possible role of periodontitis in exacerbating Alzheimer’s disease. Periodontitis may bear the potential to affect the onset and progression of Alzheimer’s disease. Periodontitis shares the two important features of Alzheimer’s disease namely oxidative damage and inflammation, which are exhibited in the brain pathology of Alzheimer’s disease. Periodontitis can be treated and hence it is a modifiable risk factor for Alzheimer’s disease. – Serum Antibodies to Periodontal Pathogens are a Risk Factor for Alzheimer’s Disease

this is an excellent study from the above link, read a poignant clip of it below:

In the current study, both the AD and MCI subjects demonstrated significant elevations in antibody to P. intermedia and F. nucleatum at baseline, prior to diagnosis of the neurological changes. Additionally, the AD subjects expressed significantly elevated antibody to T. denticola, and P. gingivalis at baseline. These sera were obtained years prior to the clinical diagnosis of AD or MCI, while subjects were still cognitively normal. Therefore these elevations cannot be attributed to secondary effects of the AD disease process, such as poor nutrition or other dementia-related neglect. While it could be suggested that the antibody to these oral pathogens may have been cross-reactive with antigens from other sources, the literature is replete with studies supporting the specificity of these antibodies for oral infections [20–21, 43–46], and that successful treatment and maintenance of periodontitis significantly lowers these antibody levels [47]. Comparison of these antibody levels to those described in numerous populations show levels in the AD and MCI subjects in the current study to be similar to chronic periodontitis patients [45–49]. Interestingly, the control group also showed antibody levels higher than healthy values for four of the seven bacteria (A. actinomycetemcomitans, C. rectus, T. forsythia and P gingivalis) with three of the four at levels consistent with chronic periodontal disease. This may be because the study population was older, with a mean age at baseline of 70–74 years of age and periodontal disease occurs more frequently in elder adults. Regardless, the levels of antibodies in the control group were significantly less than the levels of those who converted to AD at baseline for five of the seven bacteria studied.

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

For more information about Alzheimer’s:

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 repetitive 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.  Definitive treatment should also include Oral DNA salivary pathogen testing not only to target more effective treatment strategies but also to definitively determine if the therapy has been effective in eliminating periodontal pathogens.

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.


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


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

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


10258455_513396562121311_3120797390772880421_o   10333521_513396685454632_5747976624814085827_o

      Before RPE                                                         6 months after 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,  implant, and crown.


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

1069982_570180563023132_1146475634_n  994205_570181866356335_176672911_n

#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



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

(This patient is a heavy smoker)


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)


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


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


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.



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!


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


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


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 – facing extractions       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.


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


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


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 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

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.


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℠.