Perioscopy

Perioscopy //Innovative technology as an alternative to conventional periodontal surgical approaches// By: Lori Clahane & Sharn Samra



//Goal: To promote awareness of innovative non-surgical periodontal technology in dental hygiene //

**Objectives: What can I expect to learn?**

**1) What is Perioscopy?** **2) Background** **3) How does Perioscopy work?** **4) Training for Perioscopy** **5) Will Perioscopy hurt the client?** **6) Who qualifies for Perioscopy?** **7) How long does a procedure using Perioscopy take?** **8) Does insurance cover Perioscopy?** **9) Who is using Perioscopy?** **10) Advantages and disadvantages** **11) Before and after results** **12) Videos** **13) Related published articles**

= What is Perioscopy? =

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- Also known as periodontal endoscopy

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- Uses advanced technology and great magnification to achieve visual access to root surfaces

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- Decreases the need for periodontal surgical intervention = =

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">Periodontal endoscopy can also be used to help diagnose <span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">- Root fractures <span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">- Root anomalies <span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">- Subgingival caries (Splinder Periodontic Specialists, 2011)

<span style="color: #008080; display: block; font-family: Georgia,serif; font-size: 140%; text-align: center;">"Following blind root planing, as much as 50% of the subgingival calculus beyond a depth of 4 mm remains" (Carroll, 2005)

**Background:**

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%; text-align: center;">- Clinical practice of periodontal endoscopy began in October 2001.

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%; text-align: center;">- The first dental Perioscope was named the DentalView DV2 Perioscopy System.

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%; text-align: center;">- Dentalview has since changed company ownership and has been renamed Perioscopy Incorporated. Dr. J.Y. Kwan is a pioneer in this realm of periodontics. He is the President and CEO of Perioscopy Incorporated and operates in California. Another similar periodontal endoscope system is called PerioPeak.

(Carroll, 2006)

**How does Perioscopy work?**

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- Periodontal endoscopy provides 24x to 48x magnification of the root surface using fiber optic technology

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- A special "explorer" instrument is used

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- Images are captured onto a fiber that is connected to the explorer

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- A single-use sterile sheath covers this fiber. This is where water is <span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">flushed through it and into the sulcus to provide a clear view

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- The image is transferred to a screen so that the dental professional can see the magnified root surface (approximately 3mm is viewed at one time) <span style="font-family: Georgia,serif;">

<span style="color: #15351b; font-family: Georgia,serif; font-size: 200%;"> Two types of explorers are used: <span style="color: #15351b; font-family: Georgia,serif; font-size: 200%;">//1) Shielded (indicated for periodontal debridement)// <span style="color: #15351b; font-family: Georgia,serif; font-size: 200%;">//2) Unshielded// (Kwan, 2005)

**Training for Perioscopy**





<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">Learning how to master a periodontal endoscope is a difficult task

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;"> A lot of practice is required in order to be comfortable and successful <span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">with this instrument

<span style="color: #bf245f; font-family: Georgia,serif; font-size: 200%;">The two-handed technique is the method of recommendation:

<span style="color: #bf245f; font-family: Georgia,serif; font-size: 200%;">1) The endoscope is held in the clinician's left hand (assuming he or she is right handed)

<span style="color: #bf245f; font-family: Georgia,serif; font-size: 200%;">2) The debridement instrument is placed in the right hand

<span style="color: #bf245f; font-family: Georgia,serif; font-size: 200%;">3) The dental mirror is also held in the clinician's left hand

<span style="color: #000000; font-family: Georgia,serif; font-size: 200%;">For professional training in Perioscopy: <span style="color: #000000; font-family: Georgia,serif; font-size: 200%;">//Training seminars in the United States// <span style="color: #000000; font-family: Georgia,serif; font-size: 200%;">Contact: <span style="color: #000000; font-family: Georgia,serif; font-size: 200%;">Dr. Kwan, CEO of Perioscopy Incorporated

(Perieau, 2008)

= Will Perioscopy hurt the client? =

<span style="color: #008080; display: block; font-family: Georgia,serif; font-size: 200%;">1) There is very little, if any, discomfort during a Perioscopy appointment. <span style="color: #008080; display: block; font-family: Georgia,serif; font-size: 200%;">2) Results are less damaging to the root surface as the periodontal endoscope allows the dental professional to visualize calculus deposits instead of solely relying on tactile sensation. <span style="color: #008080; display: block; font-family: Georgia,serif; font-size: 200%;">3) Some clients can be treated without anesthesia, while other clients prefer to be numb.

(Perioscopy Incorporated, 2007)

Who qualifies for Perioscopy?

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">- Clients who are treated for initial periodontal therapy

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">- Non-surgical periodontal therapy: areas that did not respond to the treatment

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">- Suspected pathology located subgingivally

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">- Clients where periodontal surgery is contraindicated due to medication

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">- Clients who refuse periodontal surgery

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">- Clients who present with chronically inflamed or increasing periodontal pocket depths

(Perioscopy Incorporated, 2007)

= How long does a procedure using Perioscopy take? =



<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">Full mouth treatment averages between 90-120 minutes for moderate to advanced periodontitis

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">These times are based on a dental professional who is highly efficient with a Perioscope

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%;">Initially treatments may need to be split while the clinician is still mastering the skills

(Perieau, 2008)



Does insurance cover Perioscopy?

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%; text-align: center;">Generally billing for Perioscopy is not a covered benefit.

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%; text-align: center;">Therefore, the client would pay out of their own pocket.

<span style="color: #481c48; display: block; font-family: Georgia,serif; font-size: 200%; text-align: center;">Billing is usually under NON-SPECIFIC PERIODONTAL PROCEDURE

<span style="color: #854a60; display: block; font-family: Georgia,serif; font-size: 200%; text-align: left;">Perioscopy treatment is generally quite costly. However, it may <span style="color: #854a60; display: block; font-family: Georgia,serif; font-size: 200%; text-align: left;">be cheaper than periodontal surgery or tooth extractions for <span style="color: #854a60; display: block; font-family: Georgia,serif; font-size: 200%; text-align: left;">a client who does not have these procedures covered under <span style="color: #854a60; display: block; font-family: Georgia,serif; font-size: 200%; text-align: left;">their dental insurance. One quadrant fee for Perioscopy <span style="color: #854a60; display: block; font-family: Georgia,serif; font-size: 200%; text-align: left;">procedure can range anywhere from $350-$900 and this <span style="color: #854a60; display: block; font-family: Georgia,serif; font-size: 200%; text-align: left;">may increase with the use of antibiotics.

<span style="color: #854a60; display: block; font-family: Georgia,serif; font-size: 200%; text-align: left;">*Note: This information is cited from American sources

(PerioPeak, 2011)

= Who is using Perioscopy? =

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">Many dental professionals throughout the United States <span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">have incorporated Perioscopy within their practices.

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">As of yet, this technology has not been as widespread in Canada, although select dental practices do have the equipment.

(Perioscopy Incorporated, 2007)

= = = Advantages = <span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- Improves client care

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- May eliminate need for specialist referral

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- In many cases it reduces need for periodontal surgery

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- Less painful for the client than traditional periodontal therapy

= Disadvantages: = <span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- Is not covered by dental insurance

<span style="color: #481c48; font-family: Georgia,serif; font-size: 200%;">- Can be costly

(Perioscopy Incorporated, 2007)

**Before and after results:**



(Perio peak, 2011)

<span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 260%; text-align: center;">Periodontal Surgery versus Periodontal Endoscopy



<span style="display: block; font-family: Tahoma,Geneva,sans-serif; font-size: 220%; text-align: center;">Videos

media type="youtube" key="dTdh6mNtZ-c" height="364" width="531" align="right" media type="youtube" key="lqBSIsY2pRE" height="362" width="479" align="left"



Quiz: 1. What is the magnification of the Perioscope? a. 1-2x b. 16-24x c. 24-48x d. 48-64x

2. How long does the average appointment take for a Perioscope trained dental professional?

3. Approximately how many millimeters of surface space does the Perioscope allow the user to view?

4. Aside from non-surgical periodontal therapy used, what else can a Perioscope be used to diagnose?

5. What is another name for a Perioscope?

6. What year was the first Perioscope used clinically?

7. What is the preferred Perioscope technique called?

<span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 150%; text-align: left;">**Related published articles:**

<span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 150%; text-align: left;">http://www.perioscopyinc.com/HygieneTownArticle.pdf

<span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 150%; text-align: left;">http://www.perioscopyinc.com/documents/jop.2009.090160.pdf

<span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 150%; text-align: left;">http://www.perioscopyinc.com/documents/stambaugh.pdf

<span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 150%; text-align: left;">http://www.perioscopyinc.com/documents/TomWilsonArticleHisto.pdf

<span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 150%; text-align: left;">http://www.perioscopyinc.com/documents/aaplaserpositionpaperapril2011.pdf

<span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 130%; text-align: right;">Contact: Perioscopy Incorporated <span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 130%; text-align: right;">6333 Telegraph Avenue <span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 130%; text-align: right;">Oakland, California 94609 <span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 130%; text-align: right;">**T)** 510. 547.1300 <span style="display: block; font-family: Verdana,Geneva,sans-serif; font-size: 130%; text-align: right;">**F)** 510.547.4976

**Text References:**

Carrol, J. (2006, November). The evolution of care: why perioscopy could change the way you view your patients. //Modern Hygienist,// pp. 46- 48. Retrieved November 11, 2011 from []

Kwan, J.Y. (2005, March). Enhanced periodontal debridement with the use of micro ultrasonic, periodontal endoscopy. //CDA Journal,// 33 (3), pp. 243-244. Retrieved November 11, 2011 from []

Perieau. (2008). //Perioscopy: getting started// [Video]. Retrieved November 11, 2011 from []

Perioscopy Incorporated. (2007). //Perioscopy technology.// Retrieved November 11, 2011 from []

Perieau. (2008). //Perioscopy: getting started// [Video]. Retrieved November 11, 2011 from []

PerioPeak. (2011). //The cost of periodontal disease (gum disease) treatments.// Retrieved November 11, 2011 from []

Perioscopy Incorporated. (2007). //Perioscopy technology.// Retrieved November 11, 2011 from []

Spindler Periodontic Specialists. (2011). //Dental endoscopy.// Retrieved November 11, 2011 from []

**Image references:**

Centre for Oral Health Sciences. (n.d). //Basic periodontology// [Online image]. Retrieved November 1, 2011, from []

Dental mall. (2011). //Dental adornment// [Online image]. Retrieved October 29, 2011, from []

Graphic resources. (2009). //Planet earth// [Photograph]. Retrieved October 28, 2011, from []

Management Development Corporation. (2011). //Research studies// [Online image]. Retrieved October 8, 2011, from []

Palmia. (n.d). //Quiz// [Online image]. Retrieved November 1, 2011, from []

Perioscopy Incorporated. //Publications// [Online image]. Retrieved October 10, 2011, from http://www.perioscopyinc.com/publications.php

Perio peak. (2011). //How regenerative periodontal endoscopy works:// [Online image]. Retrieved October 8, 2011, from []

Spindler Periodontic Specialists. (2011). //Endoscopically assisted root debridement// [Online image]. Retrieved October 7, 2011, from []

Top news network. (2009). //Free dental care to be given on January 29// [Online image]. Retrieved October 29, 2011, from __http://topnews.net.nz/content/211398-free-dental-care-be-given-january-29__

ODEI. Cohort 9. Perioscopy. Lori Clahane & Sharn Samra. Wikispaces (2011)