By: Victor M. Sternberg, D.M.D.
August 3, 2022
I would like to share with you some results we have obtained with our perioscopic scaling. We've had the device for over 20 years and now have a chance to evaluate some of the long term outcomes.
Attached are some photographs and x-rays of cases we have treated with the perioscope. The company chose them.
Among the things that we have observed and learned are as follows:
1) Removal of all of the calculus even when visualizing it is challenging. A combination of hand instruments and a special thin Cavitron tip when utilized with direct vision using the perioscope has allowed effective debridement. However, there have been times that it took 10-15 minutes on a single tooth, even visualizing it with the camera, to remove the calculus. This has been a good indication how challenging subgingival scaling and root planing can be when done without the aid of perioscopy, and even with it.
2) The removal of the calculus has resulted in dramatic pocket reduction on singular teeth. Some of the photographs show this, as well as x-rays that reveal bone regeneration occurring over time when debridement is effective.
CASE #1 - Pocket closure and teeth moved back together spontaneously.
CASE #2 - 9MM pocket 12 years ago. Treated perioscopically. Note bone regeneration
CASE #3 - severe periodontal issues #32 to #3. #32 was extracted, perioscopic scaling, 30 of 10 follow-up.
We recently upgraded the fiber and the machine which has given us greater visibility and a much clearer image.
3) The learning is fairly steep to use 2 instruments in the mouth simultaneously and look at a screen while you're scaling; it is not intuitive. It takes numerous cases to become comfortable and more than that to become competent.
4) Patient acceptance is high. Patients are avoiding surgical procedures often that cause a great deal of recession, particularly in the anterior part of the dentition, and post-operative discomfort is minimal.
5) We have found that on single rooted teeth, pocket reduction has been dramatic. However, less so on posterior teeth where there are bony defects or molar furcations.
6) We often culture the patients to determine which bacteria are present before we do the perioscope so we can reduce the inflammation with systemic antibiotics targeted for those specific organisms. This has made the use of the perioscope more effective since we have less granulation issues to deal with.
Elimination of the subgingival flora, or its marked reduction, also aids in the healing process.
If any of you are interested we would be more than happy to share this technology with you and we welcome visitors to the office who wish to observe a perioscopic scaling being done.
Victor M. Sternberg, D.M.D.
By Westchester Center for Periodontal & Implant Excellence
January 9, 2023