Regenerative Periodontal Endoscopy - RPE

RPE is a unique non-surgical, synergistic regeneration approach, combining several advanced technologies.  What makes RPE unique is the timing and technique of each technology used.   RPE is not merely a perioscopy procedure, it is a protocol designed specifically to arrest periodontal disease and regenerate the bone which has been lost around the teeth.

The RPE Protocol:

A safe and effective enzyme inhibitor medication (sub-antimicrobial dose doxycycline) - SDD - sets the stage for success with this non-invasive approach by suppressing the destructive enzymes involved in periodontal disease.  This medication has a powerful anti-inflammatory effect on the gums.  When SDD is combined with the microscopic removal of calculus (perioscopy), followed by coating the roots with regenerative proteins (emdogain), the results are remarkable.

While no formal research yet exists on this innovative synergistic 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.

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.

 

  
10  months after RPE - normal healthy tissue 3mm- bone regeneration well underway, no mobility, and no need for an extraction and implant.  He saved thousands of dollars.

       
Before 10mm pockets           15 mo’s after RPE - bone fill- no mobility

This patient was told she needed to have this tooth extracted and an implant and crown placed.  She saved thousands of dollars in treatment costs, and did not have to undergo surgery by having non-surgical RPE instead.

     
Before and after photos for the above x-rays - very healthy tissue. 

 

    
Before -  7mm pocket           3 months after RPE- bone filled in, no longer a need for extraction of this front tooth and bridge.

   

before - 10mm pockets 

       
        3 months after RPE - 3-4mm probings - she avoided extraction of the molar tooth and bridge as well, saving thousands of dollars in treatment costs.

 

 

 

Before RPE - 8mm

2 weeks after RPE - 3mm - see x-rays below

 

Before x-ray #28 mesial

only 8 weeks after - rapid bone fill

 

   
Before - 7mm pockets         6 weeks after - rapid bone fill

    
Before - 8mm bony defect 19D            After RPE - 3mm probing

 

       

(above)  Before  10mm                          3 mo’s after - 4mm

 
     6 mo’s after - rapid bone fill occuring

      
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.

    

before RPE - 9mm                       only 6 weeks after - 3mm with rapid bone fill

 

    

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 20mg taken twice daily, and thoroughly cleaning the roots using perioscopy. 

One third of the population has a genetic tendancy to develop periodontal disease, one half of those individuals will develop advanced periodontal disease.  RPE can effectively interupt and reverse this grim outcome for millions of individuals by combining several advanced technologies synergistically.

For more information about sub-antimicrobial dose doxycyline go to host modulated therapy.

For more information about regenerative proteins go to www.straumann.com or www.osteohealth.com

before RPE - bleeding and infected 15mm pocket tooth #6

3 months after RPE - 4mm - very healthy tissue - no bleeding

Before - 9mm infected advanced periodontal pocket- tooth #8 is mobile

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

Before - severe inflammation - 7mm pocket tooth #26

After RPE - minimal inflammation - pink, healthy tissue - 3mm

Before - severe inflammation - 5mm pocket #22

After RPE - tight healthy gums - 2mm

Before - 10mm

3 weeks after RPE - 3mm tight, healthy tissue

Before - 7mm - severe inflammation

3 weeks after RPE - 2mm - very healthy tissue

Before - 11mm pockets #24 and #25

After RPE - 2mm - healthy

Scientists have recently discovered what appears to be a definitive link between pancreatic cancer and periodontal (gum) disease. Pancreatic cancer is the fourth leading cause of cancer deaths in the U.S. because it is so difficult to treat. More than 300,000 Americans are expected to die from it this year.

The study found that men with periodontal disease have a 63% greater risk of developing deadly pancreatic cancer. The research studied 51,000 professional non-smoking males from 1986 to 2002. It may be that the chronic inflammation from periodontal disease is setting off an inflammatory response which is detrimental to overall health, or that the bacteria associated with periodontal diseases are the culprit. More research is needed to determine the actual action periodontal disease has in creating a higher risk of cancer.

At PerioPeak Innovations we are committed to ending chronic periodontal disease and the inflammation associated with it. By using an innovative approach involving advanced miniature fiberoptic technology and host modulated therapy, the periodontal inflammation and infection can be very effectively put into a remissive state for the long term…lowering the overall health risks associated with all stages of periodontitis or gum disease.

Below are recent articles about the link between periodontal disease and pancreatic cancer:

http://abcnews.go.com/GMA/OnCall/story?id=2813658&CMP=OTC-RSSFeeds0312

http://www.healthandage.com/public/news/10328/Link-is-found-between-periodontal-disease-and-pancreatic-cancer.html

http://www.medicalnewstoday.com/medicalnews.php?newsid=60977&nfid=rssfeeds

http://www.healthcentral.com/newsdetail/408/601047.html

Perioscopy is only one part of the synergistic RPE - Regenerative Periodontal Endoscopy - protocol, but is crucial to excellent overall results for many reasons. Perioscopy is a non-invasive way to view and clean root surfaces without surgery using micro-diamond ultrasonic tips.  The dental endoscope fiber optic is less than 1mm in diameter and incorporates tremendously powerful illumination and magnification.  It is essentially like using 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 skill and experience to perform perioscopy with proficiency.  It also requires the proper pairing of technologies to achieve consistently great results.

Early perioscopy research revealed clinical results never before thought possible.  The ability to treat all stages of periodontal disease without surgery was a tremendous breakthrough.  The early research and numerous publications can be reviewed at www.perioscopyinc.com.  However, this early research was only the beginning…at PerioPeak Innovations, regenerative periodontal techniques aimed at ensuring long term results has been our mission for nearly a decade, taking perioscopy to a much higher level with RPE - Regenerative Periodontal Endoscopy.

Why may perioscopy yield better results clinically than root planing, laser periodontal therapy, or flap/osseous gum surgery?  It’s simple.  None of these procedures employ the use of a sub-gingival microscope (dental endoscope).   Perioscopy is highly definitive and effective when used properly. The following post will help clarify this concept.

Below are four still endoscopic pictures viewing the area between the root and gums (the sulcus) during perioscopy.  Images provided by DentalView, Inc. (taken by Gayle Meyers, RDH and Roger Stambaugh, DDS)

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.  It is left behind following traditional root planing because it is very smooth and can fill depressions, furcations, and flutings in the roots.

Burnished calculus may be left on the roots following traditional root planing.  Burnished calculus cannot be seen or felt with traditional techniques beyond a depth of 4mm, and 30-50% of the root may have residual calculus; infection and inflammation 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 highly experienced individuals using a dental endoscope.  Surgical microscopes and loupes do not reveal this truth because they do not incorporate 48X magnification with tremendous illumination.  In addition, a surgical microscope cannot be placed beneath the gums.  Note: Only a scanning electron microscope on extracted teeth will reveal the equivalent detail.

SCI 0:  Subgingival Calculus Index Zero is what we refer to as “perioscopy clean”!  This is the goal of non-invasive perioscopy treatment.  This can only be achieved profficiently and thoroughly through many years of perioscopy experience.

The objecive truth about current traditional techniques was not known until the innovation of dental endoscopy (perioscopy).  Using lasers beneath the gum blindly, root planing tactiley/blindly, or performing surgery without an endoscope, may allow toxic calculus to remain embedded in the roots, hence, periodontal inflammation and infection ensue.

Removing microscopic toxins from the roots allows the body to heal by allowing reattachment to occur.  When perioscopy is combined with regenerative proteins and sub-antimicrobial dose doxycycline, regeneration and long term results are possible.  RPE using perioscopy is performed in one appointment without the need for repetative treatments.

9-5-06

I was afflicted with very severe periodontal disease for well over 15 years. During that time I had been treated by 3 highly recommended periodontists. In each case I underwent repeated treatments only to be told afterwards that my case was beyond treatment and that a whole mouth (or near whole mouth) extraction was required. Am I ever glad that I didn’t throw in the towel, and also that I came upon Judy’s clinic.

Without undergoing surgery, Judy managed to fully restore my oral health. I’ve kept all my teeth with no threat of loosing any of them anytime soon. For the first time in decades I do not suffer from root sensitivity or abcesses. This treatment really works. I would encourage anyone with any degree of periodontal disease to seek it out.

Dr Bruno S Marcoccia.

Federal Way, WA

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9-17-06

Judy,
I just can’t tell you in words how much all you’ve done has meant to me.  You are an amazingly special woman and I can’t sing your praises highly enough to everyone I meet!
I really want you to know how much finding Periopeak and having the perioscopy treatment has meant to me - I feel like a huge burden has been lifted from my shoulders (not to mention my teeth!) and I know I’ve been blessed to have been able to find you (and Louanne, too!).  You’re always in my prayers and I hope you’ll keep in touch.

Oh - I almost forgot - we absolutely LOVED Seattle - we went to Pike Place market before we left and bought a couple of pounds of salmon & Dungeness crab and lugged it home on the plane.  We also spent an entire day (I think it was Fri) driving all around Olympic Nat’l Park - took the ferry - drove to the Quileute Indian reservation, LOVED the Pacific Ocean at La Push, drove back down 101, saw Ruby Beach (excellent!), found a place called Kalaloch Lodge that we hope we’ll be able to get back some day to stay at - it’s so beautiful there.  Drove 5 through Olympia, Tacoma and then back up to Lynnwood.  We were exhausted, but happy!!

Thank you again for all you’ve done.  I am so lucky to have found you.  I wish the same for my fellow periodontal sufferers.

We’d love to take you up on your “salmon feast” offer when we manage to get back to Seattle - I’ve already told Russ I’m planning on going back to you for my one year checkup!!!

Thank you, thank you, thank you.

All the best,

Lucy
New York

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9-20-06

Hi Judy,

Well, good news! I just got home from the dentist and having my teeth cleaned and pockets probed and x-rays. All GOOD! Sammi Snyder from Dr, Haddads office will be sending my probing results and x-rays to you. So much new bone, you just wouldn’t believe it. You will be so proud. They (and me), were so excited. And the fun thing for me was that the cleaning and probing did not hurt at all, almost no sensitivity. Almost no bleeding.

My teeth just feel stronger in my mouth.

I know Sammi would love to be doing what you do, of course she doesn’t have the equipment, but some day, I hope.

I hope you are doing well, and that you are convincing more people to do your perioscopy technique, It really works.

I’ll go back on Dec 20 for cleaning and probing and x-rays (7 months by then), and see how far we are with bone growth.

Hope you’re well.

thanks for everything.

Sue

Oregon

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9-25-06

Hi Judy!

I’m sure all of your patients gush about the great work you do and I am no different.  You’ve relieved a lot of stress in my life and you made our trip to Seattle a treasured memory.  And I lost 5 pounds, ON VACATION.  That NEVER happens.  But I guess 4-5 hours on Mt. Rainier can do that for you.

I’ve never been anxious to go to the dentist, but I can’t wait for my first check-up so he can see your work.

Thanks again for everything and for the work you do,

Rebecca

Ohio

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11-4-06

Judy,

I have been remiss in contacting you to let you know how wonderful it was to meet you.  My teeth feel fabulous.  I keep resisting the urge to wiggle that tooth that was sooooo loose.  I just did and it feels tighter already!!!  Yeah!
I have told everyone…even people who werent interested (smile)…about how terrific you are and how amazing the procedure was.  I had a little tenderness and swelling from the laser procedure but thats it.
My gums actually feel different.  They feel tighter and more normal if thats a description.
I went on two tourist tours and enjoyed every minute.  I saw the salmon steps and the locks.  I spent the rest of the time walking and resting.  I truly enjoyed Seattle.  I really needed the rest also.
Thank you so much for taking me to lunch at that lovely restaurant.  It was truly the best meal I had while I was there.

Finding you and saving my teeth has been a turning point in my life.  Thank you.

Again please forgive me for taking so long to express my gratitude.

Love Chris

Florida

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12-19-06

Hi Judy,

I just got back from my first dental appt. since the perio treatment.  I was nervous.  Everyone was so anxious to get a look at my mouth and hear all about the procedure. The hygienist was new and had just seen my chart for the first time.  After reading your letter she couldn’t wait to get started.

This is how the conversation went……”Wow……..wow,wow……oh my gosh, this is so exciting……incredible……..I can’t wait to get done with work so I can check out her website…….I’ve never seen anything like this before.

She GENTLY checked some of the pockets and continued to be amazed.  My 9mm’s were down to 4mm’s. She’s anxious for my next checkup so she can do a little more.  Needless to say Dr. Cobb was just as amazed and anxious to learn more about your treatment.  I wouldn’t be surprised if you hear from him.  He’s a great guy and cares very much about people (just like you).

I couldn’t wait to get home to give you the update. I’ll no longer be anxious about going to the dentist.

Again, from the bottom of my heart, thank you.

Rebecca

Ohio

P.S. My mom told HER dentist about the results and they are VERY interested.  So if you get inquiries from Southern Ohio, you’ll know we’ve been telling EVERYONE.

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1-22-07

Oh My Heavens!!!So much time has gone by so quickly. Please forgive me for not getting right to you to tell you how fabulous I’ve been doing.  Your ears should be buzzing all the time because I haven’t stopped talking about the wonderful experience of finding you,  and how great your work was when I was in your chair.  MY FRONT TOOTH IS ONLY A TINY BIT LOOSE. Tiny,tiny.  I’m soo happy since it was so loose before your treatment I was afraid to touch it because it was so loose I thought it was going to fall out. No pain, no more gum abscess. All my other teeth feel tighter and “healthy” .  I am so grateful.
I’m afraid to let anyone touch my gums. I can’t afford to come back for a three month cleaning but I hope to come out for the 6 month cleaning.  What should I say to the dental hygeinist about how not to disrupt your work.
You are one of the sweetest people.  I will always be gratefull  for  your fantastic passion to save peoples teeth.  You have saved mine.  Happy New Year!! Love Chris

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1-27-07

Judy,
THANK YOU so much for inviting me to your lecture-it was inspirational and very informative.  As I gain more experience I hope to work one day for a periodontist who has a perioscope…Even though  I haven’t been practicing long at all I know that I do not do the best job I can do (no matter how thorough I am) simply because I do it blindly.
I really wish I was at least shown what a perioscope is and what it does while I was in school….Shoreline students are so lucky to have you as their speaker!   I am still on the look out for a patient to refer to your practice for tx…
Thank you again for sharing your knowledge, experience, and passion!
Zhanna

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2-1-07

Hi Judy,

I thought the x-rays looked good….”hopeless” should be removed from periodontal vocabulary!  Interesting, I do not even know which is 31 (please describe location).  I am assuming I would not do any root canal(s) until the emdogain has had a full year to perform…please advise if that is correct….thanks!   Maybe by then, you will come up with an easy procedure that replaces root canals (may be closer to the truth than we think!)  The gingiva by 19 is still quite receded….any chance that it will grow back?

I am so very pleased that I followed my instincts and that I found you and went with your program instead of the very grizzly and old fashioned periodontal approach!

Many thanks and much gratitude,

All the best,

Bonnie

Colorado

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03-12-07

Dear Judy

I want to thank you for the work you have done on my teeth to date. Your enthusiasm, dedication and passion for saving peoples’ teeth and mine in particular have been impressive and it has helped me through a difficult period.

When Dr. “X” told me some months ago that I had no choice but to have all my teeth extracted I was dumbfounded and confused. I knew that my teeth were not the best in the world and that I did have periodontitis, but I did not think that my condition was that terminal!

Researching on the web and talking to people, I discovered the Perioscopy technology and then through you learned about Emdogain.  As I researched the topic more and more, and discussed with you and others, I realized that I had an alternative and was going to give it a fair, fighting chance.

I knew that four teeth were goners and that the future of two more could not be guaranteed but I still wanted to give it a try. Following the two Perioscopy sessions with you, the Emdogain treatment and the increased emphasis on my own personal dental hygiene (flossing daily, electric toothbrush, and quarterly visits to the dental hygienist), I think that we have the situation under control and in check. That is why I decided to start the implant treatment to restore the gaps. It looks like only four will be necessary and that the two no-guarantee teeth are going to be okay.

As you know my main concern was not cosmetic, my smile has always been a bit crooked but I wanted to keep my own teeth for as long as possible, and enjoy eating and drinking and really tasting what is in my mouth.

Your dedication to the furtherance of the Perioscopy technology and your desire to save people from having their teeth extracted too soon and unnecessarily, are to be admired. I know that you will continue with such energy, and that is why I have written this letter in the hope that you will share my experience with others who have similar problems.

Thank you very much for everything.

Regards,

Steve

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05-12-07

Hi Judy,

Thank you for taking the time to speak to me the other night.  It was truly inspiring and put a spark back in me that I haven’t had in a while.  I got into hygiene to make a difference and kind of lost focus somewhere along the way.  After talking to you, I posted some of our conversation and your website.  My class is truly excited about the perioscopy and hopefully created some buzz in them.  Good luck with all that you do, your amazing and don’t forget that.

Blessings, Lisa Behrens RDH

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11-15-07

Hi Judy,
I don’t know if you’ll remember me, but here goes…

I came to you from New York back in 2004 August.
Mine was a challenging case and you worked on me for several hours.
After the session, you and I and the doctor you were with at that time (I forget his name), had a discussion about
very low dose antibiotics to follow the periopeak treatment and how I used it to treat rheumatoid arthritis too.

Well, I’m happy to say 3 years later, that my periodontal problems are a thing of the past.
All my loose teeth are firm and I have no pockets!
You set the stage and the low-dose ABs did the rest.

If you recall, I then moved to India.
I have been here ever since and have set up an alternative medical center.
I have used a similar approach to gum disease on several people with very good results.
I always speak about you…telling others in India about your technology.

I have been meaning to write to you…and now finally I got down to it.
I will most probably be sending you a friend of mine who lives in Los Angeles…she needs the treatment badly.
I am also looking for a way to introduce the periopeak technology in India…has the company worked out their growing pains and production shortages?

Do drop me a line when time permits…it will be lovely to hear from you.
Good luck,
Suresh Shottam