What is Perioscopy?

What is Perioscopy, or periodontal endoscopy, and how does it 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 gum pockets (if the clinician is skilled), 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 We view this narrowly focused use of the periodontal endoscope as an outdated understanding for the overall comprehensive and skilled use of this technology.

The dental endoscope, or periodontal endoscope, is a flexible fiberoptic endoscope (less than 1mm in diameter), which incorporates powerful illumination and 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 two decades on thousands of clients with advanced periodontal disease. During that time we have treated many patients who underwent 'perioscopy' in offices with clinicians lacking good training, protocols, and/or overall experience.  At this time there is no certification of any kind required to provide perioscopy or periodontal endoscopy procedures and diagnostics.  We feel strongly that this leads to a negligent disservice to the patient. PerioPeak Innovations hopes to change and enhance the education and training to require certification in the future.

More information to help clarify Periodontal Endoscopy and Perioscopy further below.

 

Below are four still endoscopic pictures viewing the area between the root and gums (deep gum pockets) during a periodontal endoscope procedure.

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).

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

Burnished calculus is typically left on the roots following traditional root planing (SRP), LANAP, and even following traditional flap surgery in advanced furcations. Burnished calculus cannot be seen or felt with the above traditional techniques. 30-50% of the root surface (beyond a pocket depth of 4mm) may have residual calculus if an endoscope is not utilized. Inflammation and infection may persist.

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 illuminated loupes (magnified glasses with a headlamp) do not reveal this truth because they do not incorporate powerful magnification (48X or more) 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 level of detail.

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

The limitations of current traditional techniques, such as root planing, was unknown until the innovation of the periodontal endoscope - we simply didn't know. 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, cell death, and infection may continue.