Regenerative Periodontal Endoscopy - RPE(TM)

RPE is a unique non-surgical, synergistic periodontal therapy approach, combining advanced technologies.  What makes RPE unique is the timing and technique of each technology used.  A safe and effective enzyme inhibitor medication (www.periostat.com host modulated therapy) sets the stage for success with this non-invasive approach by addressing the destructive enzymes involved in periodontal disease.   When this medication is combined with the thorough 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 synergistic approach (RPE), there is impressive research on each technology studied independantly, demonstrating efficacy and statistical significance (improved clinical outcomes) in the treatment of periodontal disease.

Before and After RPE - Case Studies: 

                               Before - 12mm pocket -  advanced bone loss

       10  months after RPE - normal healthy tissue 3mm- bone regeneration well underway

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

Before and after photos for the above x-rays - healthy tissue, no mobility.  This patient was able to avoid an extraction, bone graft, and implant...she saved thousands of dollars.

Before -  7mm pocket                       3 months after - bone filled in

       Before  - 10mm pockets                                   3 months after RPE - 3-4mm probings

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

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

                Before RPE                                               3 months after - rapid bone fill

     Before RPE - mobility - 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 #18M - 9mm                          6 weeks after - 3mm - rapid bone fill

Before RPE  - severe inflammation                              3 months after RPE - 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 low dose doxycycline 20mg taken twice daily, and thoroughly cleaning the roots with perioscopy.  A full third of the population have a genetic tendancy to develop periodontal disease, and one half of those individuals will develop advanced periodontal disease.  Low dose doxycycline can effectively help to interupt this grim outcome.

For more information about low dose doxycycline 20mg for periodontal disease treatment, go to

http://periopeak.com/dasblog/CategoryView,category,Host%20Modulated%20Therapy.aspx

For even more information on low dose doxycycline, also known as sub-antimicrobial dose doxycyline, or PerioStat, go to www.periostat.com.

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

How regenerative proteins work - http://periopeak.com/dasblog/CategoryView,category,Bone%20Regeneration%20-%20NonSurgical%20Bone%20Regeneration%20with%20Emdogain.aspx

Periodontal Disease Pictures - Before and After Non-surgical RPE

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

How Does Perioscopy Work?

Perioscopy is a non-invasive way to view and clean root surfaces using micro-diamond ultrasonic tips and a dental endoscope fiber less than 1mm in diameter with tremendously powerful illumination.  The image is viewed live on a high resolution flat screen monitor at 24-48X magnification.  It takes a great deal of skill and experience to perform perioscopy with proficiency.  It also takes 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.  This early research was only the beginning...at PerioPeak Innovations, regenerative periodontal techniques aimed at ensuring long term results has been a labor of love, taking perioscopy to another level with RPE(TM) - 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)...one cannot effectively remove toxins from the roots if they do not even know they exist. 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 individuals using a dental endoscope.  Surgical microscopes and loupes do not reveal this truth because they do not have 48X magnification with tremendous illumination as well. In addition, a surgical microscope cannot be placed beneath the gums.  Note: Only a scanning electron microscope on extracted teeth will reveal this detail.

SCI 0:  Subgingival Calculus Index Zero is what we refer to as "perioscopy clean"!  This is the goal of non-invasive perioscopy treatment. 

We did not discover the "ugly" objecive truth about the ineffectiveness of our current traditional techniques until the innovation of dental endoscopy (perioscopy).  Using lasers beneath the gum blindly, root planing blindly, and/or 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 and regenerate.  Perioscopy is performed in one appointment without the need for repetative treatments.  At PerioPeak Innovations we have combined several advanced technologies to create and restore periodontal health.

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

________________________________________________________________________________

9-17-06

Judy,

RPE(TM) - Regenerative Periodontal Endoscopy

Non-Surgical periodontal bone regeneration is finally possible thanks to a new biological technology called Emdogain(R) 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 low dose doxycycline used synergistically.  Emdogain is typically used only in conjunction with some type of periodontal surgery.  There is no published research on this technique and protocol at this time.

So what exactly is Emdogain?

In short, it's affectionately know as "piggy juice".

Emdogain contains Enamel Matrix Protiens, or Bioactive Molecules, called amelogenin proteins, and it comes from the developing teeth of 6 month old 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 human body responds by growing new cementum, ligament, and alveolar periodontal bone 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: This beautiful regeneration process would be completely interupted by the use of lasers and/or antibiotics placed under the gum.  Periodontal regeneration needs time and patience only.  Efficient microscopic root debridement and soft tissue curettage is performed using a dental endoscope with micro-diamond piezo ultrasonics.  this creats a perfect environment for periodontal health and regeneration.

Below are Surgical Case Studies Using Emdogain: 

Here is what this exciting biological technology can do for you and/or your patients with bone loss! True periodontal regeneration...the patient grows their own bone...beautiful!  However, these cases are SURGICAL.  PerioPeak clinicians perform this treatment utilizing a dental endoscope instead of surgery.

Below is bone regeneration in a posterior tooth involving a furcation (bone loss between the roots - normally a scenario for an extraction).

       

Courtesy of Dr. Anthony Polimeni, Huntington, NY

Non-Surgical Endoscopic Regeneration using Emdogain: 
 

                   

           Before                                             15 months after

Courtesy of PerioPeak Innovations (Judy Carroll)

To view more non-surgical periodontal treatment cases go to

 http://www.periopeak.com/gum-disease-cases-seattle/index.htm 

and

 http://periopeak.com/dasblog/CategoryView,category,Case%20Studies.aspx

The DV2 Dental Endoscope 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

http://www.straumann.com/com_index/pi_index/pi_ch_periodontal.htm

Non-Surgical RPE has opened the door for an effective non-invasive periodontal treatment option.

Surgical Approach    vs         Non-Surgical RPE

Which technique would you choose?

 Patient Testimonials: http://www.periopeak.com/gum-disease-alternative-seattle/index.htm

                              http://periopeak.com/dasblog/CategoryView,category,Testimonials.aspx

One third of the population have a genetic tendancy to develop periodontal disease.  Many people are born with a "sensitivity" to plaque bacteria. One could describe it as an "allergy". For these individuals, plaque causes inflammation on contact and triggers their immune system to go into hyperdrive, creating an overproduction of harmful enzymes, thus periodontal destruction ensues.   

For more information on genetics and periodontal disease go to these sites:

http://www.perio.org/consumer/geneticbasis.htm  http://www.dentistry.com/articles/Genetic_Marker_Discovered_for_Periodontal_Disease.aspx  http://www.umm.edu/patiented/articles/who_gets_periodontal_disease_000024_4.htm 

The good news is that advanced technologies will now allow us to alter the usually predictably poor outcome of genetic periodontal disease. Host factors, such as genetics, must be addressed to effectively put periodontal disease into remission. No longer will only cutting the pockets out with surgery, or only doing perioscopy, be the entire "cure".

Individuals with a genetic predisposition must be identified before anything we do clinically will be successful long term. These individuals over-produce destructive enzymes four fold, which causes severe destruction of the periodontium. The chronic nature of this disease can fool even the most astute clinician. Damage to the periodontium can occur quickly or slowly, therefore, preventative care becomes crucial.

Utilizing a safe and effective "Host Modulated Therapy" (low dose Doxycycline 20mg -LDD), or PerioStat(TM), will considerably change the course of chronic periodontal disease.

Low Dose Doxycycline 20mg (LDD) - Subantimicrobial Dose Doxycycline  www.periostat.com

"Host Modulated Therapy", or low dose doxycycline 20mg, also known as "subantimicrobial dose doxycycline (SDD)", is one of the most effective ways to control systemic host factors associated with chronic inflammation in periodontal diseases. Host factors may include genetics, smoking, diabetes, AIDS, hormones, medications contributing to periodontitis, and stress.

More about host factors in periodontal disease:

http://www.umm.edu/patiented/articles/who_gets_periodontal_disease_000024_4.htm

Low dose doxycycline, 20mg taken twice daily, slows the progression of the disease by suppressing the "over-production" of a destructive enzyme called collagenase.    

Over-production of collagenase before LDD - the body is out of balance due to host response - chronic inflammation - break down is exceeding repair and bone loss results.

Normal collagenase levels restored by LDD - equal breakdown and repair occuring.  Stability and health is restored. 

LDD puts collagenase levels back into balance.  Although doxycycline 20mg, or PerioStat, is in the tetracycline class of drugs, its use is often misunderstood.

At this very low dose, it is sub-clinical (sub-antimicrobial dose), meaning it has no effect on the bacteria whatsoever; only the production of the destructive enzyme collagenase is suppressed.  The therapeutic benefit has nothing to do with killing bacteria; that is not the goal.  To kill bacteria, doxycycline would have to be at a much higher dose.

This medication is powerfully effective at reducing and/or eliminating chronic periodontal inflammation.  Thus, it is one of the most valuable tools available in the fight against periodontal disease, especially if there are systemic host factors which cannot be controlled.

Other benefits of taking LDD daily include keeping blood sugar levels in check in diabetics, lowering CRP (C-Reactive Protein) levels and cholesterol in patients with chronic periodontitis and cornonary artery disease.  LDD is effective in the successful treatment of rosacea and rheumatoid arthritis.

Preventative periodontal care is about helping a patient to understand what is causing their disease, giving options for treatment, and reasonably predicting long term outcomes.  There are host factors which cannot be controlled with all the best intentions.  Low dose doxycycline (LDD) is one of the most powerful tools available to alter the course of periodontitis safely.

excerpts from Journal of Clinical Periodontology 2004 Sept.;31(9):697-707

Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis. A review.

Preshaw PM, Hefti AF, Jepsen S, Etienne D, Walker C, Bradshaw MH.

School of Dental Sciences, University of Newcastle upon Tyne, UK.

Studies have shown that SDD, when prescribed as an adjunct to scaling and root planing (SRP), results in statistically and clinically significant gains in clinical attachment levels and reductions in probing depths over and above those that are achieved by SRP alone. SRP must be thorough and performed to the highest standard to maximise the benefits of adjunctive SDD.

SDD does not result in antibacterial effects, or lead to the development of resistant strains or the acquisition of multiantibiotic resistance. The frequency of adverse events is low, and does not differ significantly from placebo.   

Articles about sub-antimicrobial dose doxycycline (SDD):

http://uuhsc.utah.edu/pharmacy/bulletins/doxycycline.html

http://www.umm.edu/patiented/articles/how_antibiotics_being_used_long-term_prevention_of_periodontal_disease_000024_9.htm 

http://www.natural-hrt.com/artman/publish/article_133.shtml

http://ezinearticles.com/?Low-Dose-Doxycycline-Therapy&id=552971

Published research with low dose doxycycline:

http://www.ncbi.nlm.nih.gov/pubmed/15766366?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

The connection of periodontal disease and overall health has actually been "known" for 100's of years, but now the research is starting to support that claim.  Finally, the health connection has been made...the most significant movement in the history of dentistry is here and it is gaining momentum...it is long overdue! 

Periodontal disease has now been linked with  heart disease, stroke, diabetes, and pancreatic cancer.  The list of serious health complications associated with periodontal disease is growing and the studies surrounding these findings has been given priority in recent years.  The mouth afflicted with periodontal disease is full of ulcerations (periodontal pockets), and is an easy "breeding ground" for opportunistic pathogenic bacteria, which then enter the blood stream and infect other areas of the body, setting off a dangerous chronic inflammatory response in the body.  These toxic bacteria have been found in the arteries of heart attack and stroke victims, and have also been found in the placenta.

The goal at PerioPeak Innovations is not only to eliminate the periodontal pockets harboring dangerous bacteria, but also to stop the chronic inflammation associated with gum disease and other serious health problems.  We take a complete "cause and effect" approach which addresses all the health issues associated with periodontal disease.  We successfully treat the source of the disease, not just the effect.

This insidious disease of chronic infection and inflammation should not be ignored.  We can no longer take a "head in the sand" approach to periodontal disease. 

Unfortunately for the person with periodontal disease, it is for the most part a painless condition, therefore it may not be discovered early enough so periodontal surgery and/or extractions may be indicated.  Undiagnosed periodontal infection festering beneath the gums wreaks havoc in overall health, elevating the inflammatory mediator response, and setting off a cascade of dangerous problems.

Below are links with recent information and studies about the connection between periodontal disease and overall health:

• December 2005 - Readers Digest - How your dentist can save your life http://www.rd.com/content/openContent.do?contentId=19084
• January 2006 - ADA/Colgate Begin Oral Systemic Education Campaign http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1611
• January 2006- CIGNA begins Dental Oral Health Maternity Program http://www.cigna.com/health/consumer/dental/oral_health_maternity_program.html
• January 2006 Canada Begins Just Say Gingivitis Program http://www.justsaygingivitis.ca/english/2006%20contest/default.asp?s=1
• February 2006 - First Joint ADA-AMA Conference http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1815
• March 2006- Consumer Articles Increase - Save Your Smile and Health http://www.azcentral.com/health/news/articles/0321dentalsins0321.html
• March 2006- Aetna-Columbia U. Research- periodontal care appears to have a positive effect on the cost of medical care, with earlier treatment resulting in lower medical costs for members with diabetes, coronary artery disease (CAD), and stroke. http://www.aetna.com/news/2006/pr_20060317.htm  

It's important to ask questions about the current condition of your gum health...it's more important than we ever realized.

In addition to having a tremendous passion for non-surgical approach periodontics through perioscopy, Judy's enthusiasm and passions extend to her time outdoors in the beautiful Pacific Northwest enjoying a variety of activities.  Growing up in the shadow of Mt. Rainier created a natural love and close connection with "The Mountain" as it is referred to in Washington State.  Sharing the beauty of Mt. Rainier with her out of town clients has become one of the most enjoyable "perks" to Judy's business.

Judy's son Joseph poses with the wild flowers at Paradise on Mt. Rainier.  He's eagerly hiking his way up to play in the snow at a little higher elevation in August...he loves the snow!