Portions of the Case Study submissions for the Perio Protect Orkos Award Winners are shown below:
Conservative Treatment Helps Avoid Gum Surgery
Dr. Craig Buntemeyer and hygienists Selena Murtaugh and Candice DeHues of Tulsa, Oklahoma received the Orkos Award for successfully treating a patient with severe gum disease using minimally invasive dentistry. The patient had not seen a dentist for several years and presented with deep pockets and very inflamed gum tissue. At the initial exam, 100% of all the patient’s pockets were bleeding and 74% of all pockets were deeper than the normal 1-3mm depths. The conservative and effective minimally invasive approach helped the patient avoid surgery and arrested the disease.
After a comprehensive exam on February 7, 2012, a complete periodontal chart was taken. The photo indicates the serious state of the patient’s disease.
Dr. Buntemeyer and his hygiene team discussed treatment options with the patient and the patient decided to start treatment with non-invasive Perio Tray delivery of medication. The prescription trays and medication (Perio Gel with 1.7% hydrogen peroxide) were delivered on February 28. The patient returned three weeks later on March 20th for a full mouth debridement and instructions to continue tray usage.
Click to enlarge probing charts
One week after full-mouth debridement and daily use of Perio Tray delivery for one month. Visual results before SRP.
Image taken one week after full mouth debridement and daily use of Perio Tray delivery of hydrogen peroxide gel for one month. A week after this image was taken, SRP was completed (April 12). The patient continued to use Perio Tray delivery at home between office visits. He returned in August when this picture was taken.
Six months after treatment began.
At his most recent periodontal maintenance visit on October 10, the patient has maintained his results. Bleeding sites were reduced from 100% to 27%. His pocketing over 3mm was reduced from 74% to 25%. With ongoing perio maintenance, the doctor, the hygienists, and the patient are looking forward to maintaining or even improving on these excellent results.
Helping Fearful Patients Accept Treatment
Seattle-based Dr. Jim Coleman and hygienists Karla Middendorf and Paula Kingsley received the Orkos Award for demonstrated excellence in a case study report involving a patient with advanced gum disease and significant fears regarding pain management. By introducing the patient to non-invasive technology, Dr. Coleman’s team helped him alleviate his fears and accept treatment. “The qualifying evidence presented by Dr. Coleman was of particular interest,” explains Dr. Tanya Dunlap of Perio Protect LLC, “because the patient would have faced surgical intervention which he was unlikely to accept, leaving his disease unchecked. It is so important for patients to get treatment and, as this case study demonstrates, helping patients overcome their fears can make a significant difference.”
Like many people across the country, the 62 year-old, non-smoking patient in this case study feared and avoided needed dental procedures until his gum disease was quite advanced. He found Dr. Coleman’s office after his previous dentist retired. On his first visit, Dr. Coleman diagnosed him with advanced periodontal disease (vertical and horizontal bone loss, 5-7mm periodontal pockets, and 37% bleeding on probing). Bacterial testing (Hain Diagnostics) revealed high levels of bacterial communities associated with gum disease (Aa and red complex bacteria).
To help alleviate his new patient’s fears, Dr. Coleman prescribed Perio Trays® to deliver medication under the gum line before root debridement therapy. The medication delivered with the special customized Perio Tray begins to address the biofilm infections causing the disease. When the patient returned after 20 days of Perio Tray and medication usage, pocket probing depths decreased by 1-3mm and bleeding decreased from 37% of probing sites to 14%. Bacterial testing indicated significant (90%) reductions in harmful red complex bacteria. Pretreatment swelling of the gum tissues had also subsided.
Despite the initial positive treatment response, the patient still feared the necessary root debridement therapy. When the patient returned a month later, Dr. Coleman prescribed an anesthetic gel delivered in the Perio Tray before the mechanical procedure. With this additional pain management step, root debridement therapy was successfully completed in one procedure. The patient was instructed to continue to use Perio Trays with medication until the next appointment.
Follow up chart #1 Perio Probing Chart
6 weeks after starting Perio Trays
(June 28, 2010) <Click chart to enlarge.>
Hygienist Karla Middendorf described his results as outstanding at the recall visit six weeks later, with only 3% bleeding on probing and no pockets measuring over 4mm. She also noted that the gum color returned to a healthy pink. According to Middendorf’s colleague hygienist Paul Kingsley who also worked with the patient, the anesthetic gel in the Perio Trays made a huge difference for this patient. “With the delivery of the numbing agent deep into the pockets,” Kingsley explains, “perio maintenance visits were much more comfortable for the patient; consequently he kept his appointments, we were able to complete the treatments, and the positive results have been maintained long-term.”
Long-term success is the ultimate goal. The Perio Tray delivery of medication is a significant advancement in patient treatment options because patients use it at home between office visits to help manage the bacteria causing the disease. The Perio Tray can be used by patients with all stages of disease, and it is designed for maximum patient comfort and convenience. Kingsley believes that when patients have access to the best tools, they have more options for proactive treatment and they are more hopeful.
Dr. Coleman initially was interested in the Perio Tray delivery of medication to help his patients with physical disabilities, like Parkinson Disease or strokes, who are now dependent upon their caregiver for their daily oral hygiene. What he and his team discovered, recounts Kingsley “was a tool that is so much more comprehensive, affordable, simple and effective for all of us and our patients.” Dr. Coleman then decided after seeing “off label” successes, why not use it for what it was design for, treating patients with periodontal disease. Middendorf, who has practiced hygiene with Dr. Coleman for 16 years, uses Perio Trays herself for preventative care: “I use it so I don’t ever develop periodontal disease. I see what many of my patients deal with – bone loss, bad breath, local and systemic infections – and I want to avoid it for myself.” Laura Brecht, a dental assistant in Dr. Coleman’s office, explains that she uses the Perio Tray delivery of medication to reduce calculus buildup and eliminate the “itchy” gums she had around a crown. Dr. Coleman also had trays made for his own personal use after seeing the benefits.
"Before" Image <Click image to enlarge.>
"After" Image (3 months) <Click image to enlarge.>
The move Dr. Coleman’s team made toward minimally invasive dental care with the non-invasive Perio Tray is indicative of his emphasis on thinking “outside the box” and embracing evidence-based science through technology. “The science behind the Perio Tray delivery of medication wowed us,” said Kingsley, “it allows us to offer targeted treatments for the biofilm cause of the disease and it has changed the way we practice.” Dr. Coleman has been in practice for 20 years in Burien, WA following a successful dental career in the US Navy.
Protecting Extensive Crown and Bridge Work
Dr. Gregory Sopel received the Orkos Award for excellence in a case study treating a patient with diseased periodontal tissues surrounding extensive crown and bridge work. The margins on the porcelain fused to metal crowns were originally hidden subgingivally and over time the surrounding tissues became inflamed with corresponding heavy bleeding. The problems were magnified by the extent of the crown and bridge work stretching from ear to ear.
The patient visited Dr. Sopel for the first time in March 2011. While no pocket measured more than 5mm at that initial comprehensive periodontal review, the inflammation and bleeding indicated surgical intervention and significant changes to the crown margins were needed. Dr. Sopel offered the Perio Protect Method to this patient as an alternative option in hopes of avoiding extensive surgical work, crown reparations, and all of the associated costs. As Dr. Sopel explained the associations between chronic gingival inflammation, bleeding and systemic diseases and described the non-invasive approach. He also cautioned the patient that some surgery could still be necessary. The cost of the surgical plan and crown restorations was estimated at over ten thousand of dollars.
The patient agreed to try the non-invasive approach first, and Dr. Sopel prescribed Perio Trays and medication. With good patient compliance the treatment worked well. Bleeding on probing decreased significantly (33 sites to 3 sites), tissue inflammation subsided, and, at the patient’s most recent hygiene visit only one pocket measured 4mm. The rest were 3mm or less. At this time, Dr. Sopel has decided that surgery is no longer warranted and that redoing the extensive crown margins can be reduced to rebuilding one crown.
The patient was so happy with his results that he began to tell people about his treatment success and his dentist. In fact, Dr. Sopel was first identified as an award candidate because of the patient’s enthusiasm. He called and mentioned that he could be the spokesperson for Perio Protect and highly recommended his dentist.
We congratulated them both.
Click to enlarge probing charts
Treating the Fearful
Hygienist Kim Stevens and Dr. Howard Schwadron are recognized with the Orkos Award for excellence in a case study treating a patient with severe periodontal disease and a fear of subgingival debridement. The patient’s condition was first documented by Kim Stevens, RDH in 1995 and detrimentally progressed over the years. From 1995 to 2007 the patient insisted that Dr. Schwardron treat her exclusively and repeatedly refused scaling and root planing (SRP), only consenting to topical scalings and polishing. By 2007 when the doctor told her she had to have scaling and root planing or lose her teeth, she consented to a hygiene appointment with Stevens.
At the September appointment in 2007, Stevens completed a comprehensive periodontal exam. The lower arch contained the deepest pockets measuring 10mm. Tooth #31 was in the worse shape. It had drifted mesially in the absence of #30 and pitched forward. There was 100% bleeding on probing and the bleeding was heavy. Because Dr. Schwadron’s office uses Florida Probe® charting that digitally announces pocket depths, bleeding, and exudate, the patient had to acknowledge the situation. As Stevens recalls, “The patient was so afraid of scaling and root planing that I purposely avoided those terms and reiterated Dr. Schwadron’s message that a deep cleaning was needed, but she adamantly refused. I was frustrated.” Stevens then told her the only thing left to try was a relatively new, non-invasive delivery of medication with prescription Perio Trays®. “But,” Stevens confided recently “I didn’t think it would work. I thought she would lose her teeth. At the time, I thought, how can you get any good results without removing the tartar?” The patient agreed to this non-invasive approach and Dr. Schwadron prescribed Perio Trays®.
Just short of two weeks later, the patient returned to receive her prescription trays, medication and wearing instructions. They scheduled an appointment two weeks later to monitor conditions. The patient then cancelled that appointment along with two more. When she returned two months later, as Stevens recollects, “her entire countenance was different. She just kept smiling. I will never forget it,” Stevens said. “I looked in her mouth and I couldn’t believe what I saw. Her gums looked pink, not purplish red from disease, and the clinically visible calculus documented in September was no longer there. I backed away from the chair, said her name, and she said ‘I know!’ “
With this initial success, the patient readily consented to a perio maintenance visit with Stevens one month later, January 24, 2008. As Stevens explains, “I had to really hunt to find any calculus and her measurements were so much better. She had just a few fours, mostly 2’s and three’s and the tens now measured fives, with no bleeding all. Her tissue was coral pink and her gums were tight.”
Follow up chart #1 Perio Probing Chart
1 year after starting Perio Trays
(January 24, 2008) <Click chart to enlarge.>
The patient continued to use the Perio Tray delivery of medication as directed. Tooth 31 could not be saved but all of the remaining teeth were. By August 22, 2011, improved conditions were maintained. Deep and bleeding pockets that measured 49% of all sites at the start of treatment had all been resolved.
Importantly, recession did not increase. “Improvement in recession is rare when inflammation is reduced this dramatically,” Stevens notes. “The tissue generally shrinks when inflammation subsides but it often does not reattach and recession increases. In this case, recessed, rolled inflamed tissue not only resolved but also reattached in most places.”
Dr. Gordon Wilson received the Orkos Award for a case study involving a patient with generalized early periodontitis and localized areas of moderate and severe periodontitis. The 54-year-old patient was referred to Dr. Wilson by his general dentist because the patient insisted on trying to save six of his teeth in jeopardy of extraction. At the initial exam, Dr. Wilson agreed with the referring dentist that at least two of the teeth were likely to be lost, but the patient persisted and volunteered to do “whatever it takes to save a tooth,” including the 200 mile drive to Dr. Wilson’s office for multiple visits. The treatment plan included the Perio Tray delivery of medication, laser therapy, scaling and root planing, and, if the teeth were viable after 9 months, root canal therapy. The patient made good on his promise, following the homecare directions and commuting the long distance for his appointments. The treatment proved so successful that only one tooth (#2) was extracted and Dr. Wilson was able to plan necessary restorative work.
The basic treatment plan for this case study followed Dr. Wilson’s patent-pending protocol to treat and maintain all stages of periodontal disease, which he calls Therapeutic Laser Care (or TLC) 4 Gums. With TLC 4 Gums, all patients use Perio Trays to deliver medication for treatment and long-term maintenance. Scaling and root planing is supplemented in more severe cases with laser therapy as needed.
At the initial visit in June 2010, special attention was paid to the six teeth that were in danger of extraction (numbers 2, 3, 7, 10, 14 and 15). Upon reviewing the full-mouth x-ray, Dr. Wilson expressed particular concerned about tooth #10, which exhibited class III mobility and excessive bone loss. The only thing that appeared to hold this tooth in place was diseased gum tissue which a laser removes. If the patient insisted on attempting to save this tooth, not only was the concern that the tooth would exfoliate, but also that the patient might experience such severe post-operative pain that he would want the tooth extracted immediately. Compounding the problem was the fact that the patient lives over 200 miles from the office. By the time he returned home, the effects of the anesthetic would have worn off and the post-operative pain would have set in.
Despite these concerns, the patient insisted that he would do "whatever it takes to save the tooth". So treatment proceeded. Given the severe conditions and unclear outcome of initial therapies, the patient agreed to treatment for a period of nine months, at which point a complete re-evaluation would be completed both for the periodontal disease and potential restorations. The patient was informed that if there was any hope of saving #10 and #14; these teeth would require root canal therapy; however, if these two teeth exhibited mobility after nine months, they agreed to consider their efforts a failure and extract the teeth.
The first step involved equilibrating the occlusion with the aide of the T-Scan, making sure to remove all premature and excursive contacts on the six teeth that were deemed to be "hopeless." The patient was also placed on an oral antibiotic. Next, the teeth and surrounding tissue exhibiting moderate and severe periodontitis were treated with an Nd:YAG laser, and root planing was performed generally. Impressions for Perio Trays were taken and medication was prescribed for Perio Tray delivery with instructions for daily use at home. Three months later, significant initial healing results indicated that new Perio Trays were necessary, and Dr. Wilson prescribed new Perio Trays according to the improved patient conditions
In March of 2011, at the nine-month mark, the patient returned for evaluation. A periodontal maintenance was completed and the most threatened teeth, # 10 and #14, were evaluated. Neither tooth exhibited mobility. Additionally, periapical radiographs were taken of both to evaluate the bone. The results were unexpectedly positive, and the patient was referred to an endodontist for root canal therapy on #14. Dr. Wilson performed root canal therapy for #10. All work was completed by July 28, 2011.
Follow up chart #1 Perio Probing Chart
1 year after starting Perio Trays
(June 17, 2011) <Click chart to enlarge.>
Since late July 2011, Dr. Wilson and the patient have moved forward with crown preps. At the September 16, 2011 visit, continued healing in terms of pocket probing depths and bleeding on probing was noted. Dr. Wilson expressed confidence that the treatment efforts have paid off and that five of the six teeth are likely to be saved. “It will be exciting to see the continued general healing and the osteogenesis around these two teeth in particular in the coming months and years,” he explained. “Our plan is to spot treat the remaining deep pockets with laser treatment and continue to use Perio Trays to deliver medication to the areas requiring osteogenesis.” Dr. Wilson notes that success in this case should also be credited to the patient. “He improved his homecare with the Perio Tray delivery of medication, he drove so far for our appointments, he genuinely made good on his commitment. This kind of patient interaction and success make dentistry so rewarding.”
Dr. Martin Schroeder received the Orkos Award for excellence in a case study treating a patient with severe periodontal disease. Before treatment, the patient had very deep pockets, measuring up to 9mm, with 69% of all sites bleeding upon probing. A prior dentist had referred him to a specialist who had recommended surgery. The patient sought a second opinion from Dr. Schroeder to learn if the Perio Protect Method might help him avoid surgery. Dr. Schroeder explained that the Perio Protect approach starts with the prescription tray delivery of medication, followed by mechanical debridement, then scaling and root planing as needed. He also cautioned that this patient’s condition was very serious and that surgery may be needed. The patient committed to the treatment. As evidence of his commitment, he even quit smoking.
After the patient had used the prescription tray to deliver medication for approximately 3 weeks, he returned for a follow up visit. No pocket measured more than 6mm and bleeding was reduced to 9%. That day a full mouth debridement was done and the next appointment was scheduled. The patient continued to use the tray delivery of medication at home between appointments. When he returned six weeks later, there was no bleeding and the deepest pocket was 4mm, save one 5mm pocket. Site specific scaling and root planing was done. At the recall appointment 6 weeks later, there was no bleeding and no pockets deeper than the accepted normal depth of 3mm.
Follow up visit #1 Perio Probing Chart 3 weeks after starting Perio Trays
(June 16, 2009) <Click chart to enlarge.>
By following the homecare protocol with the tray and medication, the patient not only avoided surgery, but scaling and root planing was reduced from four visits of quadrant procedures to one visit. Within weeks of treatment, the patient reported that he “feels better.” He was so happy with the results of the minimally invasive approach to treat his infected gums that he decided to have restorative work done.
Note about the above charts: In Dr. Schroeder's office, all pocket depths measuring 1-3mm are charted as 3mm, reflecting his primary concern for bleeding pockets and deep and bleeding pockets.
Reducing 92% Deep Bleeding Pockets to 4%
RDH Mimi Myers and Dr. Jared Mosley in Fresno, CA received the Orkos Award for a case study involving a 35-year old patient who had avoided a dental office for 20 years. The patient first visited on January 4, 2011 with the following symptoms:
Necrotizing Ulcerative Periodontitis (NUP)
Fetid "foul" breath (fetor oris)
Punched out papillae (extremely inflamed gum tissue)
Red to purple to white gingival tissues
Spontaneous heavy bleeding with 100% bleeding on probing
Dr. Mosley prescribed customized Perio Trays® to deliver medication before scaling (deep cleaning) so that medication could begin to fracture and debride the calculus, making the necessary in-office cleaning procedures more comfortable for the patient and easier to complete. The patient received her Perio Trays® and medication January 18, 2011 with daily usage instructions. When she returned to the office two weeks later on February 8, the calculus was pitted and fractured and had begun to disassociate. Tissues were flatter with some resolution in inflammation, exposing subgingival calculus. Foul breath was mild. Scaling was completed on her right side at this appointment.
Intra-oral photos dated February 8, 2011 show the fractured, pitted calculus that had begun to disassociate.
Above is "Before" Perio Probing Chart
Above is "After" Perio Probing Chart
<Click to enlarge above probing charts>
When the patient returned April 4, 2011 to complete scaling procedures, Mimi Myers documented that the tissue on the right side (scaled on 2/8/11) was coral, pink, firm, stippled, and reportedly pain free. Breath was normal. Importantly, bleeding on this side was reduced from 100% to 3%.
Intra-oral photos dated April 4, 2011 indicate clean teeth and healthy tissue.
At the May 17 recall visit, Mimi Myers recorded just 9 bleeding points (6% of all pockets down from 100% in January) and significant decreases in pocket depths. Deep and bleeding pockets that accounted for 92% of all pockets at baseline measured just 4% on May 17. Due to the healing, the patient needed a new set of Perio Trays® that would precisely fit the healthier gums and was eager to receive them. She also scheduled a re-care appointment at which time an update to her treatment plan will be made to determine if additional site specific scaling is needed. Mimi Myers reported that the patient is very happy with these initial results and the comfortable care she received.
Strong Gag Reflex
Dr. Patricia Stoker received the Orkos Award for her work treating a patient with gum disease who also suffers from an extremely strong gag reflex and significant anxiety regarding dental treatment. The anxiety is serious enough that the routine task of taking a full mouth series of radiographs had to be broken up into several appointments.
Due to the gagging reflex and anxiousness, the patient has extensive experience refusing mechanical treatment in several dental offices which left her frustrated and discouraged. She was referred to Dr. Stoker by another patient whose husband had been successfully treated in Dr. Stoker’s practice with the Perio Tray® delivery of medication under the gums. The patient started the non-invasive delivery of medication with the Perio Tray® shortly after her new patient visit.
The patient needed anti-anxiety medication before every procedure. In order to obtain the impressions for the prescription Perio Trays®, the patient took valium premedication prior to the appointment. The patient wears one Perio Tray® at a time to decrease the gagging associated with having something foreign in her mouth.
Before treatment, the patient had 133 bleeding sites with probing depths up to 7mm.
At a recent hygiene visit, she had 10 bleeding points with the deepest probing depth at 5mm. These results come from daily use of the Perio Tray® delivery of 1.7% hydrogen peroxide gel. No other treatment has been rendered. “While we continue to recommend mechanical debridement for the remaining pockets that continue to bleed or that measure more than 3mm,” Dr. Stoker explains, “she resists the recommendation. She is pleased with these results and is healthier than she has been in many years.”
Click to enlarge probing charts
Reducing 100% Bleeding to 2%
Dr. Terry Deeter, RDH Amber Olsen-Rambur and RDH Shannon Davis share the Orkos Award for their case study documenting substantial reductions in bleeding on probing and pocket depths with minimally invasive dentistry. The patient in this case study presented on August 5, 2008, with 100% bleeding on probing and pocket depths up to 6mm (1-3mm is considered healthy). Dr. Deeter first prescribed customized prescription trays to deliver medication into the pockets and followed with site specific laser treatment.
The patient received her prescription trays and medication (active ingredient 1.7% hydrogen peroxide) on August 26, at which time she was instructed to wear her trays four times a day for 15 minutes to place the medication into the periodontal pockets and to continue brushing and flossing. No other procedures were preformed at this time. When she returned to the office for her first recall visit on September 10, an examination found that bleeding was reduced to 57% and pockets had responded with 1-2mm depth reductions. The patient was instructed to continue with the specialized tray delivery of medication four times a day and to return in a month. At the second recall visit on October 8, bleeding on probing measured 4% and pocket depths showed continued improvement. The few pockets over the normal depth of 3mm were treated with laser therapy on January 13, 2009.
Twelve months later, the patient returned to the office and all pockets except for one measured within normal range. Bleeding remained low at 2%. This patient carefully followed her treatment protocol as outlined by Dr. Deeter and emphasized by hygienists Olson-Rambur and Davis. “The treatment results are exciting,” said Olson-Rambur, “because we were able to obtain such good results with the medication in the trays before site-specific treatment with the laser. Patients like the minimally invasive approach. The side effect of gradual tooth whitening is also appreciated.”
Click to enlarge probing charts
100% Deep and Bleeding to 1%
Dr. Aziza Askari’s patient came to her office wanting a new smile. The patient had not kept regular dental appointments in many years and requested treatment necessary to improve his health and to create a new smile. After discussing his health care options for his severely infected gums, he chose full periodontal treatment followed by tooth alignment, implants, veneers and crowns.
On June 8, 2010, mechanical scaling and root planing and laser assisted periodontal therapy were performed to remove subgingival calculus, followed by antibiotic irrigation and a fluoride treatment. Impressions were also taken to fabricate customized prescription trays to place medication below the gum line.
A week later, the patient returned to Dr. Askari’s office for his prescription trays and medication. Hygienist Stacey Nikkila noted substantial improvement in the gingival tissue around the anterior teeth and recorded that bulbous tissue remained in all posterior regions. The patient was instructed to use the custom trays and medication at home for four weeks along with an electronic toothbrush and an antimicrobial rinse. When the patient returned four weeks later on July 26, 2010 for his recall visit, deep and bleeding pockets had decreased from 100% to 1%. The frequency of medication delivery with the customized tray was continued with improved results. While the few remaining deep pockets required additional attention, the patient chose to start alignment of his teeth to further improve his smile. Importantly he continues to care for his periodontal health and maintain regular visit with Dr. Askari for continued success.
RDH Stacey Nikkila reports that the patient is extremely happy with his results.
Click to enlarge probing charts
Before (6/8/2010) and After (8/10/2010) pictures are above.
96% Bleeding to 4%
Documentation from Dr. Stephen Gordon (Chicago, IL) indicates a significant reduction in bleeding on probing and pocket depths for his patient in this case study. The patient has a long history of gum care. In 1999 she had a gum graft surgery, followed by regular intervals (every 4 months) of periodontal maintenance visits to her periodontist. At her maintenance visit in August 2009, a second surgery was recommended. She wanted to avoid another surgery and sought a second option.
The charting at the top right comes from the initial visit with Dr. Gordon, the dentist who gave her a second opinion. He recommended customized prescription tray to place medication in her pockets between office visits. She agreed. At a subsequent visit, specialized impressions were taken for customized tray fabrication. She received her trays on October 9, 2009 and the first recall visit occurred on October 21, 2009, at which the second perio charting was taken. This patient faithfully delivered the prescribed medication with the prescription trays 5x/day for 12 days. No other treatment was performed during this time. Her results indicate 96% of sites bled on probing before treatment and only 4% after the initial 12 days.
Click to enlarge probing charts
New Hope When Conventional Therapy Failed
RDH Barbara Tritz and Dr. Caron Nelson Glickman from Duvall, WA received the Orkos Award for their case study demonstrating how bleeding on probing was effectively managed with prescription tray delivery of Perio Gel-H (1.7% hydrogen peroxide) for a patient with profuse bleeding and pockets up to 6mm.
This long-time patient practiced excellent oral hygiene and made regular perio maintenance visits, but when bleeding on probing increased in December 2009 the dental team became concerned and offered treatment using prescription Trays to deliver medication into his pockets. The patient agreed.
After using the customized prescription trays for two weeks, six times a day, he returned to the office and a probing revealed that bleeding was significantly reduced. Several of the deeper pockets (5-6mm) had begun to resolve, but a 6mm pocket remained. His microscopic slide results also improved; no spirochetes were present, while the rods and white blood cells had decreased in numbers by over 50%.
After wearing his trays six times a day for the entire month, the patient returned again. According to Tritz, “the tissues looked fabulous with no plaque, no bleeding, stippled, pink and knife edge, and his microscopic slide was filled only with cocci. This is the best his tissues had ever looked,” she recalls.
Their patient was very pleased with the positive changes he experienced in one month, as indicated in these photos:
The above video was posted on YouTube by Barbara Tritz, RDH. Description of the video: "This patient uses Perio Protect trays twice daily, with vibromycin in the trays. There was little to no bacterial activity present on the phase contrast microscope screen. Previously this patient presented with numerous spirochetes and a very active slide. This sample is from a nine millimeter pocket. His gum tissue is pink, stippled and there is no bleeding. Love Perio Protect!! "
Note: Keep returning to this site to see more Perio Protect research studies of real people in real dental offices. When Perio Protect announced this award we were swamped with the number of dentists who responded. These dentists want to share their patient results with everyone, so we will be updating this page in an ongoing effort to let their voices be heard and share the good news, that managing the bacteria that causes gum disease, or periodontal disease, in a non-invasive or minimally invasive manner (on a daily basis) IS POSSIBLE.