Posted on Wednesday, 9th September 2009 by Administrator

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:  to avoid pain and long term tooth sensitivity, to prevent 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 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”, yet some of these treatment options may hold promise to replace traditional periodontal surgery in the very near future.

Regenerative  Periodontal Endoscopy – Regeneration to close up deep gum pockets

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, a soft tissue laser, and regenerative proteins promotes rapid repair, regeneration, and remission of periodontal disease long term.  In addition, RPE is performed with very precise and efficient tools (piezo titanium and diamond coated tips), which allows skilled clinicians to complete the procedure more efficiently and prevents root damage and tissue trauma from occurring.   An occlusal adjustment is often performed to aid in overall healing.  RPE is a pioneering approach and is not widely available due to the advanced skills required and the limited availability of periodontal endsocopes at this time.  Numerous excellent case studies published over the past decade demonstrate consistency, efficacy, and long term results.   In the future, laser assisted RPE may replace traditional regenerative surgery, osseous surgery, pocket reduction surgery, and flap periodontal surgery, as well as extractions.  Teeth deemed hopeless can be treated with RPE due to the non-invasive nature of the procedure as well as the regenerative elements of the protocol.  Contact us to find out more.

Important:  This treatment option is a fraction of the cost of traditional periodontal surgery and laser periodontal surgery (LANAP).

Before RPE  - deep gum pockets                                                      After RPE

See real case studies (actual patients of PerioPeak Innovations)

Perioscopy – removal of tartar in deep pockets only

This non-invasive procedure employs the use of a dental endoscope to “see” microscopically (up to 48X) into deep periodontal pockets. This allows the clinician to better remove the tartar and plaque 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 will vary due to skill level, experience, and method.  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 of treatment.  This is unfortunate, but it may be because the techniques, proficiency, and outcomes can vary so much between providers. 

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.

Laser Assisted New Attachment Procedure – LANAP – an expensive periodontal surgery approach

This alternative treatment is actually a laser surgical procedure provided by a dentist or periodontist.  This laser treatment is intended to close deep gum pockets and regenerate the bone without actually cutting the gums with a scalpel. Potent antibiotics are taken before the surgery and the patient is given local anesthetic and sedation if necessary.  The teeth are root planed using a traditional approach (an endoscope is not part of the protocol) with a piezo ultrasonic, this is followed by lasering (cauterizing) the affected pocket to create a fibrin clot, which prevents epithelial down-growth, allowing regeneration to occur .   An occlusal adjustment is also performed. The published research is very limited at this time  – more studies are needed to demonstrate efficacy and long term results.   There are approximately 500 doctors providing this treatment.

Important consideration: This option may be as much as twice the cost of traditional periodontal surgery.

PerioProtect – a non-definitive approach for treating periodontal disease

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 for the removal of tartar from deep gum pockets, therefore periodontal infections and gum pockets 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.  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 are temporary.   Individuals considering this option should be very cautious about promises made.   The research is unremarkable at this time and does not support this option.

If you are interested in having a complementary consultation for RPE please call us today!

Posted in Alternative Gum Disease Treatment Options

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Posted on Wednesday, 9th September 2009 by Administrator

Periodontal Disease Treatment Options for Closing Deep Gum Pockets

This post will help define and clarify all “traditional” periodontal disease treatment options available, as well as introduce laser enhanced Regenerative Periodontal Endoscopy- RPE.  RPE is a breakthrough in non-invasive periodontal treatment and is offered exclusively by PerioPeak Innovations.

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 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

Advanced endoscopic regeneration procedure eliminates cutting the gums open. Instead, reattachment and regeneration of the pockets occurs in most cases.  This non invasive procedure involves the use of a periodontal endoscope (miniature fiber optic technology), a soft tissue laser, enzyme inhibitors, and regenerative proteins to stimulate adult stem cells.  All aspects of the disease process are addressed definitively with this unique protocol.   RPE may eliminate the need for aggressive periodontal surgery and extractions.  RPE is completed in one short appointment.  Local anesthetic is used for comfort.  Thorough removal of tartar, plaque and  infection beneath the gums is performed non invasively. There is no tissue trauma, no  root damage, no root sensitivity, and minimal to no gum recession and pain following this innovative procedure.

No gum gaps are created with RPE as with traditional periodontal surgery.  Deep pockets heal and close rapidly- long term results are consistently demonstrated.

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.  Root planing (deep cleaning) is generally performed with local anesthetic (Novocaine), yet is non surgical 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 (bacteria) from the roots (below the gum line) as possible by tactile means (blindly).  The deeper the pockets, the more challenging this is to do, however, since all scaling is performed by “feel” .   Often, the roots are damaged by “over-planing”, or over-scaling.   In addition, many studies over the years show that root planing beyond a depth of 4mm creates challenges for complete removal of tartar and plaque, and up to 50% or more of root accretions may be left in the deep gum pockets.  Therefore, periodontal surgery may follow a root planing procedure, and generally does in the advanced stages of periodontal disease.

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 remains in deep pockets, periodontal infections often ensue.

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.

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).

Regenerative Periodontal Surgery: 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.   Some periodontists even like to place bone grafts in addition to adding regenerative materials.  Since regenerative periodontal surgery is still an aggressive assault on the body, recession and gaps between the teeth will result.   The main limiting factors is the experience and skill of the surgeon, recession expected, and lack of desirable aesthetic outcomes on anterior teeth (front teeth), as well as the ”host response” to healing (long term results), and cost.

In addition to the aforementioned periodontal treatment options, there are methods which are considered to be ”alternative periodontal disease treatments”, which are either too new to have become “traditional”, or are just not supported by enough science.   These alternative periodontal treatment options can be found in “Alternative Gum Disease Treatment Options”.

Posted in Periodontal Disease Treatment Options

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Posted on Monday, 7th September 2009 by Administrator

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 proinflammatory mediators, which leads to an overproduction of a destructive 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

“There are two different tests your doctor can use to determine whether you have pre-diabetes:  the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT).  The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have pre-diabetes or diabetes.  If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT).”

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

3) Get definitive periodontal treatment - www.periopeak.com

4)  Look into adjunctive medication which can help. How to help control chronic inflammation and destructive levels of collagenase enzymes

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 eliminates chronic periodontal disease and helps to maintain optimal diabetic control.

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.

Recommendation:

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.

Posted in Diabetes and Periodontal Disease

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Posted on Wednesday, 8th April 2009 by judy

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 are no signs or symptoms until the disease is well into the advanced stages.  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 (white blood cells and inflammatory mediators) which cause all the 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 continue until the affected 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 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 unique and objective information.

See pictures and read about the limitations of traditional root planing

Read about genetics and periodontal disease

Posted in Signs and Symptoms of Gum Disease

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Posted on Wednesday, 18th February 2009 by judy

How to Maintain Optimal Periodontal Health

Regenerative Periodontal Endoscopy - RPE, repairs the foundation and sets the stage for optimal periodontal health by eliminating microscopic calculus (tartar) and bacteria deep below the gumline, removing infected tissue, and stimulating bone regeneration 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 distruction are addressed with RPE, maintaining excellent periodontal health becomes very easy.   We highly recommend the water pik and an Oral-B sonic toothbrush for general self cleansing.  We have found this combination of home care aids to deliver great results time and time again.  

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 science.  However, it has been our experience that regular use of this product does indeed change the nature of the calculus, making it easier to remove during the RPE procedure.  While Periogen may have benefit in dissolving calculus prior to RPE, it may also be helpful in keeping areas clean and healthy which may be more challanging for any type of regeneration, ie, advanced furcations (advanced bone loss between roots), which would be considered “hopeless” by most dental professionals. 

PerioPeak is committed to non-surgical innovations which arrest periodontal disease long term.  PeiroPeak will be actively involved in documenting live video images below the gumline to demostrate the effectiveness of Periogen.  Stay tuned for this exciting data.  This product may be key in maintaining long term periodontal health in otherwise “hopeless” multi-rooted teeth.

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 multifaceted and requires a very comprehensive and definitive professional treatment approach. 

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

www.oralb.com

www.waterpik.com

www.periogen.com

www.globaltonic.com

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”.  Much research is being conducted in this area of periodontal pathogenesis.  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, for the purpose of addressing the hyper-inflammatory mechanism internally. 

Learn more about genetic periodontal disease and host modulated therapy

Posted in Maintaining Optimal Periodontal Health

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Posted on Friday, 26th December 2008 by judy

Pictures of gum pockets and x-rays of 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 laser assisted Regenerative 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.  Regenerative Periodontal Endoscopy (RPE) is a non-invasive, definitive, yet more affordable solution 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) is highly recommended.

Posted in Stages of Periodontal Disease

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Posted on Wednesday, 24th December 2008 by judy

The Cost of Periodontal Disease Treatments: 

This post will help clarify and define the costs involved in available periodontal treatment options, including laser enhanced Regenerative Periodontal Endoscopy (RPE), osseous periodontal surgery, extractions, implants, LANAP (laser assisted new attachment procedure), traditional laser periodontal therapy, 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 Regenerative Periodontal Endoscopy is only $700 – $950, 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 psyche.  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.  Typical osseous surgery fees can range from $1500 – $2200 per quadrant (there are 4 quadrants in the mouth).  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 are the fees for LANAP – Laser Assisted New Attachment Procedure?

In our experience fees vary widely with lanap, but generally the fees are equal to or higher than traditional periodontal surgery.  Many of the treatment plans we have observed total 5-15K for a full mouth of this treatment (4 quadrants).  It is important to seek out second or even third opinions when considering this option.  Look for a demonstration by the provider of many long term case studies with before and after x-rays and pictures.  Consultations for LANAP may cost as much as $450.   Insurance may cover up to 50% of the fee.

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

This may be one of the most ineffective of all the professional options for the treatment of advanced periodontal disease, yet is still the main stream standard of care.  This non-definitive traditional approach leaves much to be desired in results in 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 4 quadrants in the mouth).  Add to this the fees for Arestin (an antibiotic) placed under the gums during this non-definitive treatment.  Arestin is charged out at $35-$40 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 is usually 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”.  There may be concerns for root charring with this method, and since the tartar and decay may go undetected for months and years,  any benefit of killing bacteria with the laser may be short term.    

Here is a systematic review of the literature recently published:

If you are treatment planned for “laser periodontal therapy” for your chronic periodontal disease, you may want to copy the literature below for your clinician to read.  The full study may be found on www.pubmed.org.

Systematic Review of Laser Therapy as an Adjunct to TraditionalRoot Planing

Background: The objective of this study was to systematically
review the evidence on the effectiveness of laser therapy
as an adjunct to non-surgical periodontal treatment in adults
with chronic periodontitis.
Conclusions: No consistent evidence supports the efficacy
of laser treatment as an adjunct to non-surgical periodontal
treatment in adults with chronic periodontitis. More randomized
controlled clinical trials are needed. J Periodontol 2008;79:
2021-2028.

What are the fees for Regenerative Periodontal Endoscopy – RPE?

The option for a much more more affordable regenerative procedure- Regenerative Periodontal Endoscopy – RPE  prevents huge costs by eliminating the need for extractions, traditional flap surgery, osseous surgery,  or laser periodontal surgery – closing up deep gum pockets, and arresting periodontal disease long term.

Fees for RPE can range from $700 per quadrant to $950 per quadrant (per section – there are usually 4 quadrants in all).  Fees for full mouth RPE treatment can range from $2800 to $3800, depending on the severity of disease and the number of teeth treated.  RPE is performed in one appointment with local anesthetic, there is no need for repetative treatments or appointments.  Periodontal pockets close within weeks following RPE - bone regeneration occurs within a few months, and results are long term. 

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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Posted on Wednesday, 10th December 2008 by judy

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 periodontal surgery.  Chronic hyper-inflammation is a host response problem and may require the addition of anti-inflammatory medications.

Posted in Alzheimer's and Periodontal Disease

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Posted on Sunday, 30th September 2007 by admin

How Laser Enhanced Regenerative Periodontal Endoscopy Works:

Regenerative Periodontal Endoscopy – RPE, is an advanced non surgical endoscopic procedure developed by PerioPeak Innovations.  The periodontal endoscope, micro-ultrasonics, and laser eliminate the need for aggressive surgery, allowing pinpoint precision for the complete removal of gum infection and tartar in deep pockets.   Emdogain, a natural regenerative protein,  is then placed in all deep gum pockets to stimulate regenerative stem cells.

RPE is completed in one simple appointment with local anesthetic, there is no need for repetative visits.  There is no pain following RPE treatment, making it very convenient for clients traveling in from out of state.  Remarkable clinical results are achieved without surgery, including  complete closure of deep gum pockets and bone regeneration.   RPE is a highly definitive, yet more affordable, alternative to periodontal surgery and tooth loss.  RPE is a fraction of the cost of traditional and laser periodontal surgery.

  Watch this short video to see how RPE works.  

The Simplicity of the RPE Protocol:

When efficient endoscopic removal of gum infection, bacteria, and tartar beneath the gums in deep pockets  is followed by coating the roots with natural regenerative proteins (emdogain), results are extraordinary.  Periodontal health is restored in many cases and regeneration may occur in deep vertical bony defects.  Watch this simple innovative procedure on our You Tube Video.

 Before and After RPE – Case Studies:

  
Before – 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 below.

  
3  months after RPE – normal healthy tissue 3mm- bone regeneration 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 – 10mm pockets tooth#10              15 mo’s after RPE – 3mm- no mobility

This patient 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

(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 – complete 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 and regeneration occur with RPE.

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

Before x-ray #28 mesial                                       8 weeks after – rapid bone fill occuring #28

   
(above) Before – 7mm pockets            6 weeks after – rapid bone fill

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

     Before RPE                                     6 weeks after – rapid bone fill

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, rapid bone fill – no fracture detected

    
(above) Before – 8mm  19D                                 After RPE – 3mm

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

Before RPE  – 12mm pocket tooth #11               3 months after - rapid bone fill – 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.

This protocol is very specifically designed to arrest the chronic inflammation associated with periodontal disease, allowing long term healing and regeneration to occur.  RPE goes beyond the short term affects and results of available treatment stratagies – including the overuse of oral or locally applied antibiotics, and laser periodontal therapy.   View more case pictures.

before RPE – severe chronic inflammation  

 
 3 months after – health restored

The patient above had root planing at the periodontist and was not satisfied that his periodontal disease was arrested.  He was correct.  Notice the severe floss cuts associated with “itchy” chronic inflammation.  This is due to an overactive immune response, similar to an allergy response.  This can be treated effectively using sub-antimicrobial dose doxycycline – SDD (low dose doxycycline 20mg)  thoroughly cleaning the roots using perioscopy, and coating the roots with emdogain for rapid healing and regeneration.

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 and statistical significance 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.  Periodontal disease is most 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  innovative regenerative proteins (Emdogain) go to www.straumann.com

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

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Posted on Friday, 7th September 2007 by admin

Pictures of Advanced Gum Disease  – 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.

Laser enhanced 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.  Bone and gum tissue is not removed, 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 periodontal regeneration.  Healing is accelerated due to the conservative nature of the procedure and reattachment occurs within days.  Since there is no trauma to the tissue, the disfigurement and recession often associated with periodontal surgery does not occur with RPE.

Tags: Case Studies
Posted in Advanced Periodontal Disease Pictures

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