How RPE Works

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

How Regenerative Periodontal Endoscopy Works:

Regenerative Periodontal Endoscopy, or RPE, is an advanced non-invasive endoscope procedure pioneered and offered exclusively by PerioPeak Innovations, or clinics certified in this technique.  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/calculus 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 picturesAdvanced Cases.

RPE is completed in one appointment with local anesthetic, there is no need for repetitive visits as with other periodontal treatment modalities.  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 testimonials

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
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.

Advanced furcation #18 – 10mm pocket
6 months after RPE – 3mm (x-rays below)
#18 before RPE (advanced bone loss)
6 months after – nice bone fill
Same patient other side #31 9mm furcation
6 months after RPE – 3mm (x-rays below)
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
6 months after RPE - 2mm
pics are for x-rays above – before – 10mm
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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 

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

Before RPE
3 years after RPE
before RPE 7mm pocket
3 years after RPE 3mm

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

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

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 RPE – 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.

Before RPE – 10mm
3 months after – 3mm (see x-rays below)
Before RPE 
6 weeks after – good bone fill occurring
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
6 months after – nice bone fill occuring – 3mm
 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.

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