Non-Surgical Services

Non-Surgical Services

Periodontal infection is typically a chronic infection that works its way further into the gum and bone over a long period of time. Because the bacteria are organized and different from the normal bacteria in the mouth, and because the bacteria invade the gum and affect the bone, many times conventional/routine cleaning does not serve well to control the infection.

This infection is typically without symptoms, such as pain. However, it can give you signs of infection such as swollen gums, bleeding, bad breath and looseness of teeth.

Dr. John Y. Kwan, a Board Certified periodontist has innovated a way to effectively control periodontal infection and help patients heal in a simple, less invasive and less expensive way. The technique is simply called "Cleaning and Disinfecting". The results of this technique have been shown to reduce "pockets", reduce bleeding and even regenerate bone. Dr. Kwan's technique has been statistically evaluated by recognized researchers at the University of Louisville, in Kentucky and the State University of New York, in Buffalo. Results of his clinical study have been presented at the International Association of Dental Research, the American Academy of Periodontology, and published in the Journal of Periodontology.

The "Cleaning" is typically done using local anesthesia, with very small ultrasonically powered probes ("micro ultrasonics"). This technology eliminates the need for scraping of the roots with hand instruments. This cleaning technique very thoroughly cleans diseased roots and pockets with micro ultrasonic vibrations of the instrument, as well as, with highly energized flushing of water irrigation. (Patients who are anxious about treatment can elect to be orally or intravenously sedated before the local anesthesia and during the treatment.)

To aid in visualization of diseased tooth roots Dr. Kwan uses a fiber optic endoscope (Perioscopy). This micro camera slips into pockets so root surfaces can be observed. For more information on Perioscopy click here

The "Disinfection" is done with an antibiotic. Because there are specific bacteria that invade the gum tissue and affect the bone, Dr. Kwan has found that a course of a systemic antibiotic helps to eliminate any bacteria residual to the cleaning. The antibiotic used may vary based on patient tolerances to different medications. When the infection is generalized it is better to use systemic medications (oral pills). However, when the infection is more localized, antibiotic gels may be placed directly into the pocket to provide the disinfection. These local antibiotics work in the gum for over a week as they dissolve.

The results of "cleaning and disinfecting" together, have been shown to be much more effective than either one alone. The procedure is one of the best approaches for giving the body a fresh start at healing the gum and bone around the teeth.

After the initial procedure, patients typically have little or no discomfort, and a reevaluation is performed after 6 weeks to check the initial response to treatment. Subsequently, patients are asked to have supportive periodontal treatments at 3-4 month intervals for one year. These treatments are micro ultrasonic cleanings (without anesthesia and without antibiotics) and are performed to support healing by keeping the teeth above and below the gumline as clean as possible. Additionally, we help our patients with their effectiveness in cleaning at home.

After a year, selected x-rays are taken and a reevaluation of the healing response is performed. At that point long term management options are discussed. Sometimes, surgical treatment is recommended. However, Dr. Kwan estimates that, of the teeth that originally have infection with pockets and bone loss, over 90% of these teeth no longer have surgical treatment recommendations (this is consistent with other published studies).


Case Studies

Examples of bone healing after micro ultrasonic debridement and short term adjunctive antibiotic therapy

 

perioscopy

Before and After

 

perioscopy

Before and After

 

perioscopy

Before and After

 

perioscopy

Before and After


 

perioscopy

Click to vew Case Presentations (large pdf file, may take a few moments to load)


 

Periodontics has made great strides in the surgical and non-surgical management of periodontal problems. With this innovative technique, Dr. Kwan has been able to allow many patients to reach periodontal health in a simple, effective, less invasive and more affordable way.

If you have any questions regarding this approach, please do not hesitate to contact us.