Regenerative Periodontal Endoscopy - RPE

RPE is a unique, non-surgical periodontal therapy approach.  By combining several advanced technologies we are able to achieve remarkable clinical results without surgery.   RPE is not merely a perioscopy (endoscopic) procedure offered by some offices, it is a unique protocol specifically designed to arrest periodontal disease, and regenerate the bone which has been lost.

The RPE Protocol:

When SDD (sub-antimicrobial dose doxycycline) is combined with efficient microscopic removal of calculus (perioscopy), followed by coating the roots with regenerative proteins (emdogain), the results are extraordinary.  Periodontal health is restored and regeneration occurs.

 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 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.  He saved thousands of dollars in treatment costs. 

                          
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 saved thousands of dollars in treatment costs, and did not have to undergo surgery by choosing the option of 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

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 9mm - #19,#20  

                                     After 1 year - 3mm - nice bone fill both teeth - surgery avoided.

Before - extraction of #18 imminent -10mm  

     

6 months later - 3mm - bone filled in

 

       Before - 8mm  

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

Before x-ray #28 mesial

only 8 weeks after - rapid bone fill occuring #28

 

   
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 months after

 

       
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 cases

    

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  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, 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.

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

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

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 non-surgical RPE and has remained stable and healthy following RPE for several 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 mobile

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 her advanced periodontal disease on all the teeth. (she had generalized 5-12mm pockets).

After RPE - minimal inflammation - pink, healthy tissue - 3mm measurements - health restored to all her gum tissues.  No longer a need for full mouth extractions.

Before - severe inflammation - 5mm pocket #22

After RPE - tight healthy gums - 2mm

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

about RPE

 

Comparison Pictures of Periodontal Surgery vs. RPE Below:

 

 

Above: This patient underwent periodontal surgery (osseous surgery) for her advanced periodontal disease (she had 5-9mm pockets generalized) - this picture is 6 months after undergoing periodontal surgery.

Above: This patient had 5-9mm pockets generalized but instead of having the periodontal surgery recommended by her periodontist, she had non-surgical RPE.  This picture is 6 months after RPE.  No tissue and bone is removed as in the periodontal surgery picture.  A superior cosmetic outcome is the result - with no gaps between the teeth and no recession of the gums.

 

RPE is a conservative treatment approach which does not cause the disfigurement often associated with aggressive periodontal surgery.  The two cases presented above had identical pocket depths.  One patient 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: Perioscopy (dental endoscopy) procedure picture:

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.  We do not remove bone, as in osseous periodontal surgery.  Instead, regenerative proteins are placed on the roots and into the periodontal pockets to regenerate periodontal ligament and bone.  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.

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 a synergistic approach involving advanced miniature fiberoptic technology, the periodontal inflammation can very effectively be 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

RPE - Regenerative Periodontal Endoscopy - using Emdogain

Non-Surgical periodontal bone regeneration is finally possible thanks to a new biological technology called Emdogain, by Straumann. But what is this stuff and how does it work? The following post will help clarify what Emdogain is and help the reader to understand the tremendous benefit and ease at which non-surgical approach using Emdogain for bone regeneration can be. Emdogain is a truly fascinating biological technology which may hold the key to a strong future in non-surgical periodontal therapy.

IMPORTANT: Emdogain is used non-surgically at PerioPeak Innovations with an innovative technique and protocol utilizing a periodontal endoscope and sub-antimicrobial dose doxycycline used synergistically. Emdogain is typically used only during some type of periodontal surgery procedure. 

So what exactly is Emdogain?

Emdogain contains Enamel Matrix Protiens, or Bioactive Molecules, called amelogenin proteins, harvested from the developing teeth of pigs.  What are enamel matrix proteins and how do they help humans to regenerate periodontal bone? The answer is in the unique biology of tooth development. When teeth are still developing, we can extract these “bioactive molecules” and use them in humans to “simulate” tooth development - biomimicry.  The body responds by growing new cementum, ligament, and bone (osteogenesis) in areas where periodontal disease has damaged these important supporting structures. The damage of periodontal disease can be repaired with Emdogain.

The Mechanism of Emdogain:

Attachment - the mesenchymal cells attach to the root surface covered by Emdogain.

Proliferation and Growth -the cells start to produce cementum. Cementum is the KEY tissue in periodontal regeneration. The recreation of alveolar bone starts from the root cementum.

Alveolar Bone - the process of mineralization starts a certain distance from the root and alveolar bone (periodontal bone around the teeth) is formed.

Note:  Efficient microscopic root debridement and soft tissue curettage are performed using a dental endoscope with micro-diamond piezo ultrasonics tips.  This creates the perfect environment for periodontal health and regeneration.    

View non-surgical bone regeneration cases using RPE techniques instead of surgery.

The DV2 Dental Endoscope with 48X Magnification. The success of non-surgical periodontal bone regeneration is highly technique sensitive and requires very specific skills, knowledge, and experience. The proper pairing and timing of several innovative technologies is crucial with this technique. At PerioPeak Innovations, we are committed to providing successful non-surgical solutions for periodontal disease, utilizing advanced technology.

The history of Emdogain:

- 1988 Biora founded by Professor Lars Hammerstrom, Stockholm Sweden.

- 1995 CE Certification

- 1996 FDA approval- 1997 introduction into the US market.

- Since 1989 produced in Malmo Sweden

- 2004 completion of integration by Straumann

There are numerous studies involving the safety, efficacy, and statistical clinical significance with emdogain.  Over 800,000 people have been treated successfully.  Go to www.straumann.com for more information about emdogain.