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Dahlén, G. (2006). Microbiological diagnostics in oral diseases. Acta Odontologica Scandinavica, 64(3), 164–168. https://doi.org/10.1080/00016350500520318

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Most diseases concerning oral health involve microorganisms that can sit and grow into a bigger problem. According to the article Microbiological diagnostics in oral diseases, “Microbiological tests can therefore be used in general dental practice to increase accuracy and quality in the diagnosis, treatment, and prevention of these diseases.” (Dahlén, 2006, pg. 2) This article provides information based on the use of microbiological testing for diagnosis, deciding treatment, and various ways for patient motivation to remove or prevent those microorganisms. Oral mucosal lesions and infections can consist of microorganisms such as Candida, Staph aureus, Pseudomonas, Streptococci, and more (Dahlén, 2006). These microbial tests can pick up on these organisms and provide great feedback for the clinician in the best treatment or plan for the patient. They can be best utilized for patients with chronic or aggressive periodontitis.

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Nagi, R., Reddy-Kantharaj, Y.-B., Rakesh, N., Janardhan-Reddy, S., & Sahu, S. (2015, October 15). Efficacy of light based detection systems for early detection of oral cancer and oral potentially malignant disorders: Systematic review. http://doi.org/10.4317/medoral.21916 

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This systematic review overviews the efficiency of devices that are created to implement tissue fluorescence and chemiluminescence for earlier detection of oral potentially malignant disorders and oral squamous cell carcinoma. Results showed that chemiluminescence increased brightness in mucosal white lesions, but may fail to spot red patches. They concluded that the two oral cancer screening devices were suitable for clinicians that were properly trained to use them as a non-invasive test, but further trials should be done to gather information on optical imaging as a tool for early diagnosis of these malignant disorders (Nagi et al., 2015, pg. 1-2)

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Husseini, A., Slot, D. and Van der Weijden, G. (2008), The efficacy of oral irrigation in addition to a toothbrush on plaque and the clinical parameters of periodontal inflammation: a systematic review. International Journal of Dental Hygiene, 6: 304-314. https://doi.org/10.1111/j.1601-5037.2008.00343.x

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This article was a systematic review on oral irrigation as an adjunct to toothbrushing and its effects on periodontal inflammation. The authors gathered data found from several articles and compared their findings on brushing alone without the use of oral irrigation. In the article, the authors state, “The adjunctive aid of the oral irrigator (OI) is designed to remove plaque and soft debris through the mechanical action of a jet stream of water… can also be used with antimicrobial agents” (Husseini et al., 2001, pg. 305). They found that oral irrigators did not have a significant effect on reducing plaque, but there were findings that supported improvement of gingival health compared to brushing alone or not using an oral irrigator.

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Wale, M., V Ramesh, D. S., Thriveni, R., & Byatnal, A. (2018). Hand-held X-ray device: A Review. Journal of Indian Academy of Oral Medicine and Radiology, 30(2), 153. https://doi.org/10.4103/jiaomr.jiaomr_36_18

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This article gives a brief overview of the purpose of hand held x-ray devices and describe the devices to be a resemblance of a photographic camera and indications for usage include nursing homes, special needs patients, or specific cases where a patient cannot use a conventional system. Details about radiation and exposure parameters are also included. The authors touch on advantages such as reducing number of retakes, ability to carry anywhere, and taking radiographs twice as fast as conventional systems. Disadvantages were also mentioned such as the operator cannot be fully in the protection zone if not angled properly, lead apron should be worn, and an experienced operator is needed for success.

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Martins, G. C., Rocha, T. G., de Lima Azeredo, T., de Castro Domingos, A., Visconti, M. A., & Villoria, E. M. (2023). Hand-held dental X-ray device: Attention to correct use. Imaging Science in Dentistry, 53(3), 265–266. https://doi.org/10.5624/isd.20230137

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This article goes into depth about the dangers of radiation and exposure when precautions are not taken during use of the hand held devices. The authors emphasize protective measures that should be taken when using these devices such as using the backscatter shield, operating with arms fully extended, and utilizing a rectangular collimators. This article supports the use of these devices as long as radio protection measures are met especially for the operator handling them.

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Danforth, R. A., Herschaft, E. E., & Leonowich, J. A. (2009). Operator Exposure to Scatter Radiation from a Portable Hand-held Dental Radiation Emitting Device (AribexTM NOMADTM) While Making 915 Intraoral Dental Radiographs. Journal of Forensic Sciences, 54(2), 415–421. https://doi.org/10.1111/j.1556-4029.2008.00960.x

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This final article dives deep into the radiation that operators are exposed to when using hand held x-ray devices. They provide visuals and statistics from the experiments and made conclusions from the data that they gathered. According to their findings, the reproductive system is the most affected while the thyroid is the least. The authors stated that the operator will sustain additional exposure and radiation, but protective measures such as using the lead apron and monitoring should be implemented when using these devices.

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This website outlines features and benefits and has the price listed.

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SUESE, K. (2020). Progress in Digital Dentistry: The practical use of intraoral scanners. Dental Materials Journal, 39(1), 52–56. https://doi.org/10.4012/dmj.2019-224 

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According to the article Progress in digital dentistry: The practical use of intraoral scanners, “An optical-impression by an IOS involves optically measuring the surface shape of the target teeth or gum directly in the patient’s mouth. It provides 3D model data, e.g., the surface formation of the abutment tooth, gum shape, opposing tooth, or dental occlusion status.” (SUESE, 2020, pg. 1) The writing describes the practical uses of intraoral scanners (IOS) and outlines the advantages, types of IOS, limitations, and its accuracy. Some benefits that were listed include reduction in risk of infection, virtual follow-ups, reducing pain and discomfort for the patient, and no temporary restorations. Some limitations that were stated include oral fluid causing measuring errors and training requirements for precise measurements. (SUESE, 2020) There are also some visual aids provided to show their detection of caries and components of the system.

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Mangano, F., Gandolfi, A., Luongo, G., & Logozzo, S. (2017). Intraoral scanners in dentistry: a review of the current literature. BMC Oral Health, 17(1), 149–149. https://doi.org/10.1186/s12903-017-0442-x

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This article provides a narrative review on current intraoral scanners and compares them to conventional impressions, lists advantages and disadvantages, and their accuracy. The authors concluded that the most vital part of an intraoral scanner are the cameras inside. These scanners can depict an accurate scan for short-term restorations, but can be more inaccurate than conventional impressions when partials or full-arch prostheses are needed.

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Advantages listed in Article #2:

Decrease in patient discomfort

Reduction in working times

Simplified procedure for the operator

Better communication and patient engagement

Time efficiency

No plaster casts

(Mangano et al, 2017, pg. 3-4)

Disadvantages listed in Article #2:

Purchasing and managing costs

Older clinicians with less experience with new technology

Frequent problems with not being able to detect deep marginal lines compared to regular impressions where they can register non-visible areas

Can not be used for fixed prosthetic restorations or long-span restorations

(Mangano et al, 2017, pg. 8)

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Al-Hassiny, A., Végh, D., Bányai, D., Végh, Á., Géczi, Z., Borbély, J., Hermann, P., & Hegedüs, T. (2023). User Experience of Intraoral Scanners in Dentistry: Transnational Questionnaire Study. International Dental Journal, 73(5), 754–759. https://doi.org/10.1016/j.identj.2023.04.002

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This scientific research report conducted a transnational survey whose respondents consisted of dentists, dental assistants, hygienists, office staff members, and more. The survey focused on specific IOS brands that were used by the audience and their satisfactions with the scanners. This article overviews the data that was collected and concluded that over half of the respondents stated a daily use of their intraoral scanner, maintenance costs varied from $100 to $1000 per year, and that the brands, Medit and Dentsply Sirona, were most commonly used.

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This website compares and provides brief descriptons for each scanner and lists different prices that they are sold for.

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Intraoral Scanner Price Guide 2024: the Cost of All Major IOS - Institute of Digital Dentistry

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Need to know the price of a certain intraoral scanner? See the price of any intraoral scanner on the market in this handy blog.

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Mascitti M, Orsini G, Tosco V, Monterubbianesi R, Balercia A, Putignano A, Procaccini M and Santarelli A (2018) An Overview on Current Non-invasive Diagnostic Devices in Oral Oncology. Front. Physiol. 9:1510. doi: 10.3389/fphys.2018.01510

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This article reviewed studies on light-based detection systems and evaluated nanotechnology implemented through these systems to help detect oral squamous cell carcinoma (OSCC) and malignant disorders. They reviewed and compared data using tables and descriptions that had brands such as Identafi, ViziLite, VELscope and gathered their data recorded on malignant disorders or lesions that were detected. It was concluded that nanotechnology alongside light detection systems has been found to have an ability to target cancer cells and be the next step in the future to help clinicians monitor oral lesions (Mascitti et al., 2018, pg. 6). Although this new technology is evolving, conventional oral examination along with tissue biopsies has still been a gold standard in diagnosing oral cancer or malignant disorders (Mascitti et al., 2018, pg. 1).

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This video goes over full-arch scanning demonstration and the fundamentals of using an intraoral scanner.

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Full-Arch Scanning Protocols | Fundamentals of Intraoral Scanning - Part 2

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Association of Oral Microbial Community Dysbiosis and Dental Disorders Among pregnant woman Attending Gatenga Health Center, Kigali, Rwanda. (2021). Journal of Medical Sciences and Health. https://doi.org/10.46347/jmsh.2021.v07i01.006

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This article was a study on pregnant women and which oral microbiota contributed to dental disease and which ones did not. During this experiment, it was concluded that microorganism such as S. aureus, Enterobacter, and Staphlyococcus spp. had the strongest involvement in dental disorders among pregnant women. They were also able to determine which microbiota appeared in women with disease and which did not along with commonalities that appeared in both. This study shows how oral microbial testing can be beneficial to providing information to those that need it specifically pregnant women to prevent oral health challenges affecting their baby.

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Suchett-Kaye, G., Morrier, J.-J., & Barsotti, O. (2001). Clinical usefulness of microbiological diagnostic tools in the management of periodontal disease. Research in Microbiology, 152(7), 631–639. https://doi.org/10.1016/s0923-2508(01)01242-6

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According to the study, Clinical usefulness of microbiological diagnostic tools in the management of periodontal disease, “The aim of this article is to provide a brief overview of different techniques (table 1) used for microbial identification in at-risk periodontitis patients and to assess the potential benefits of such techniques for periodontal therapy” (G. Suchett-Kaye et al., 2001, pg. 2). Periodontal disease is a relevant part of oral health care and this article details how various microbiological tests can be used to help identify and aid periodontal diseases. This can be an alternative option for patients that do not respond well to regular clinical strategies.

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This chart lists advantages and disadvantages of different bacterial detection methods.

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This dental office website summarizes why an oral test can be beneficial and why it should be done. They also include that costs can vary anywhere from $55 to $160 if patients do not have insurance.

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Oral Bacteria Testing At Elite Dental Studio

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Protect your health with oral bacteria DNA testing at Elite Dental Studio. Book now for personalized dental care.

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This photo is an example of an oral microbial test.

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Schwendicke, F., Samek, W., & Krois, J. (2020). Artificial Intelligence in dentistry: Chances and challenges. Journal of Dental Research, 99(7), 769–774. https://doi.org/10.1177/0022034520915714 

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This article defines artificial intelligence by, “the idea of machines being capable of performing human tasks” (Schwendicke et al., 2020). This article mainly discusses advantages and disadvantages to AI.

Some advantages they detail include:

Increasing efficiency by eliminating routine tasks

Organizing and integrating data with each other such as medical history, clinical, and demographic information

Voice or speech recognition to reduce time for record keeping

More patient participation with self-monitoring gadgets

Lower diagnostic and treatment costs

Some disadvantages mentioned include:

Loss of imagery, which plays a vital part in screening and treatment planning

Medical and dental data inaccessible due to data protection concerns

Outcomes of AI in dentistry are not readily applicable - only partially informs decision making process of clinical care

Limitations in the future

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Schwendicke, F., Samek, W., & Krois, J. (2020). Artificial Intelligence in dentistry: Chances and challenges. Journal of Dental Research, 99(7), 769–774. https://doi.org/10.1177/0022034520915714 

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This chart outlines the benefits that AI could have on dentistry currently versus how it could impact its future.

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Khanagar, S. B., Al-ehaideb, A., Maganur, P. C., Vishwanathaiah, S., Patil, S., Baeshen, H. A., Sarode, S. C., & Bhandi, S. (2020, June 30). Developments, application, and performance of Artificial Intelligence in Dentistry – A systematic review. Journal of Dental Sciences. https://www.sciencedirect.com/science/article/pii/S1991790220301434 

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This systematic review gathered data from articles such as PubMed, Medline, Google scholar, and more to analyze them and provide quantitative data. Charts and tables were included throughout the article to summarize the details of their findings on the application of AI for caries diagnosing, tooth detection and numbering, assessing root morphology, and many more (Khanagar et al., 2020, pg. 5). They concluded that AI technology based on an automated system was implemented in various dentistry specialties. Some studies have also shown that AI was able to match or out-perform dental specialists when it came to accuracy and overall performance.

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Chen, Y., Stanley, K., & Att, W. (2020, March). Artificial Intelligence in dentistry - CEPHX. Artificial intelligence in dentistry: current applications and future perspectives. https://cephx.com/wp-content/uploads/2020/03/qi_2020_03_s0248.pdf 

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This article overviews the current impact that AI has in dentistry and how it could impact the future as well. The authors provide visual aids that help show how AI can assist with caries detection and treatment planning using x-rays to interpret and aid the clinician in making decisions. For the future of AI in dentistry, they conclude that dental clinics will most likely establish a comprehensive care system that implements AI in all aspects of the appointment such as evaluation of patient data and assist the clinician by providing feedback and predicting a prognosis (Chen et al., 2020, pg. 8).

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This website discusses prices of AI software pricing and factors. Depending on the type of AI technology that is used, cost can range from $6,000 to over $300,000.

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How Much Does AI Cost? Pricing Factors and Implementation Types Explained

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Discover how much AI costs depending on the AI type and other crucial factors in this article.

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In this video, Dr. Rayan Skafi discusses artificial intelligence being integrated in the dentistry and how it works.

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How Artificial Intelligence is Reshaping Dentistry, by Dr. Rayan Skafi

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Uthoff RD, Song B, Sunny S, Patrick S, Suresh A, Kolur T, et al. (2018) Point-of-care, smartphone-based, dual-modality, dual-view, oral cancer screening device with neural network classification for low-resource communities. PLoS ONE 13(12): e0207493. https://doi.org/10.1371/ journal.pone.0207493

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This article details a device that implements autofluorescence imaging (AFI) and white light imaging (WLI) on a smartphone using an Android application to synchronize LED illumination and image capture to detect early lesions and potentially reduce mortality rates and health care cost by doing so. The data is then uploaded to a server for a specialist to review through the app and update the patient on results. This was originally designed for populations with high risk of oral cancer in remote areas (Uthoff et al., 2018, pg. 1). Throughout the article are visuals of what the smart-phone based device looks like and go into depth about how it works along with screenshots of what the Android application and results looks like. This technology is described to help oral cancer detection in under-resourced communities leading to earlier diagnosis and decrease disease progression along with death rates (Uthoff et al., 2018, pg. 16).

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 Cláudia Maria de Felício, Melissa de Oliveira Melchior & Marco Antonio Moreira Rodrigues da Silva (2010) Effects of Orofacial Myofunctional Therapy on Temporomandibular Disorders, CRANIO®, 28:4, 249-259, DOI: 10.1179/crn.2010.033

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This study analyzes the effects that orofacial myofunctional therapy (OMT) has on temporomandibular disorders (TMD). They measured reduction or remission with TMJ, mandibular range of motion, frequency and severity of signs and symptoms. Tables were included to represent their findings and they concluded that OMT does have positive effects when it comes to treating patients with TMD. There was a significant reduction in pain sensitivity, increased range of motion for the mandible, and reduced frequency and severity of symptoms (Felício et al., 2010, pg. 11).

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Papageorgiou, S. N., Koletsi, D., & Eliades, T. (2019). What evidence exists for myofunctional therapy with prefabricated appliances? A systematic review with meta-analyses of randomised trials. Journal of Orthodontics, 46(4), 297–310. https://doi.org/10.1177/1465312519880558 

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This study consisted of randomised trials to find if prefabricated myofunctional appliances (PMAs) is effective in treating malocclusion in children compared to untreated patients and conventional treatment. A total of 232 patients were used and it was found that these appliances were effective when compared to no treatment, but not as effective compared to functional appliances due to less ability in modifying skeletal growth (Papageorgiou et al., 2019, pg. 12-13). PMAs do have lower treatment costs and beneficial characteristics to reducing malocclusion issues such as overjet, overbite, and crowding (Papageorgiou et al., 2019, pg. 1).

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Research Co. , M. (n.d.). Preventive orthodontic treatment. Myobrace. https://myobrace.com/en-us/what-is-myobrace 

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This Myofunctional Research Company created the Myobrace system that is a preventative treatment to help children’s crooked teeth and their growth and development. Rather than the traditional orthodontic braces method, they formed a series of removal intraoral appliances that can be worn for a couple hours everyday and overnight. It can correct problems by straightening teeth, aligns the jaw, correct poor oral habits, and helps them swallow correctly. This website details other functions of the Myobrace, how it works, and the different stages that children ages 3-15 go through during this treatment.

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The Myobrace®System consists of a series of intra-oral appliances that are worn for one hour each day plus overnight while sleeping. The appliances assist in correcting poor oral habits and expand the arch-form while exerting light forces to align the teeth and jaws. Separate appliances are used depending on the child's age and type of orthodontic problem. In addition, the patient education program, known as Myobrace®Activities, is used to further correct the myofunctional habits causing the incorrect dental and jaw development. The Activities are to be performed twice daily in conjunction with wearing the Myobrace® appliance and consist of a series of breathing, tongue, swallowing, lip and cheek exercises.

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Preventive Orthodontic Treatment - Myobrace

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The Myobrace ® System consists of a series of intra-oral appliances that are worn for one hour each day plus overnight while sleeping. The appliances assist in correcting poor oral habits and expand the arch-form while exerting light forces to align the teeth and jaws.

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According to this office that offers myofunctional therapy, the cost can depend on a patient’s needs and findings based on the comprehensive exam. They stated that an average cost for a full treatment program can range from $1800-$2500 and some insurances may be able to provide reimbursement.

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Megan DeWalt, OMT, RDH is a Myofunctional Therapist passionate about helping clients navigate pass myofunctional impairments such as: sleep apnea, snoring, tongue-tie, digestive issues, orthodontic relapse, TMJ and so much more!

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Goldoni, R., Scolaro, A., Boccalari, E., Dolci, C., Scarano, A., Inchingolo, F., Ravazzani, P., Muti, P., & Tartaglia, G. (2021). Malignancies and Biosensors: A Focus on Oral Cancer Detection through Salivary Biomarkers. Biosensors, 11(10), 396. https://doi.org/10.3390/bios11100396

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This article has a comprehensive overview of the advantages and disadvantages that can come with using salivary biomarkers as an oral cancer screening tool for early detection (Goldoni et al., 2021, pg. 1).

Advantages that they list include:

Non-invasive

Stress free

Simplicity

Easily repeatable

No complex training required to special storage needed

(Goldoni et al., 2021, pg. 5)

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This website details the disadvantages that come with using Velscope, which is a device that uses blue light to enhance any oral mucosa abnormalities by autofluorescence. The main disadvantage that was listed is that this device has a very high rate of false positives that range from 15 to 81%. It poorly differentiates between dysplastic and benign lesions. These incorrect interpretations can lead to major problems such as patient harm with unnecessary referrals and biopsies.

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This website is VELscope, which is one of the brands that produce oral cancer screening devices and they go into depth about the cost of everything. The VELscope can cost around $1,695-$1,995 and ends up being around $1.96 per patient.

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VELscope® - Award-Winning Oral Screening and Imaging Technology

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By Wayne Rees

How Much Does the VELscope Cost?

The VELscope Vx system is one of the leading technologies for the adjunctive visualization of oral mucosal abnormalities, including dysplasia, oral cancer, infections and trauma. Any dentist considering adding an oral screening device to their practice will typically research the available technologies and inevitable come to the question of cost. While the VELscope's cost is pretty straightforward, there are some considerations worth discussing, which I will outline in this article. Please note, the VELscope is sold via a network of distributors that may offer incentives or special discounts, so the numbers discussed here will be our manufacturer's suggested retail price (MSRP).

Cost of The VELscope Vx

The VELscope Vx is offered in two packages: a standard unit and a value bundle. While the standard VELscope system offers everything you need to get started screening your patients, the Value Bundle provides a few additional options that many practices want to take advantage of.

Cost of the Standard VELscope Vx

The standard VELscope Vx system is $1,995 and includes:

VELscope Vx handpiece/charger

Patient safety glasses

Samples of VELcap and VELsheath disposables

Patient brochures

Oral Cancer Foundation brochures

On-Demand training modules

The standard VELscope package is the most affordable way to purchase the VELscope Vx system from an upfront investment perspective.

Cost of the VELscope Vx Value Bundle

The VELscope Vx Value Bundle includes a few additional options beyond the standard package. The VELscope Vx Value Bundle is $2,495 and includes:

VELscope Vx handpiece/ charger

(128) VELcap Vx disposables

(250) VELSheath Vx disposables

VELscope Vx Imaging Adapter and 7th Generation iPod touch for photo documentation

Patient brochures

Oral Cancer Foundation brochures

Waiting room posters

On-Demand training modules

The key differences in the standard VELscope Vx package and the Value Bundle are the iPod photo documentation system and the amount of disposables included.

Per Patient Cost

As with any medical or dental device, infection control and preventing cross contamination are critical to safeguarding the health of your patients. The VELscope Vx requires the use of disposable asepsis barriers for every examination. The VELcap Vx covers the lights and optics that are positioned near the patient's mouth during screening while the VELsheath covers the system handle. While not every oral screening technology requires an asepsis barrier, we feel this is an important part of the overall approach to patient screening. Here is a breakdown of the cost of VELscope disposables:

VELcaps - $230.40/box or $1.80 per patient

VELsheath - 39.95/box or $.16 per patient

Total - $1.96 per patient exam

Annual Support

There is no additional cost for technical assistance for the VELscope Vx system, so you will not pay any monthly support fees. The VELscope Vx is covered by a one-year manufacturer's warranty at the time of purchase. VELcare Product Protection is available at the beginning of your second year of VELscope ownership and extends the manufacturer's warranty annually against defects with additional coverage against accidental damage. Here is a breakdown of VELcare cost and benefits:

$395 per year for initial unit

$205 per year for each additional unit

1-year of extended warranty coverage:

Battery

Eyepiece

Power Supply

Power Cord

Charging Cradle

iPod touch adapter, parts and accessories

Includes standard shipping (inbound and outbound)

Return on Investment

We are often asked about the return on investment when discussing the VELscope. Typically, we recommend practices charge anywhere from $15-$20 per patient for a VELscope exam. If a practice scans 4 patients per day, 4 days per week, the VELscope pays for itself within two months. We also stress to our customers that the patient's ability to pay should not be a barrier to oral cancer screening - we feel screening for oral cancer is that important. Screenings with the VELscope are reimbursable under some insurance plans but we still recommend setting your per patient exam fee at a very affordable out of pocket price point to encourage acceptance of the screening.

So How Much Does the VELscope Cost?

You can anticipate an up-front investment in the VELscope will cost around $1,695-$1,995. The additional cost per patient will be around $1.96 per screening. Again, these are manufacturer's suggested prices and our distributors set the actual sale price.

In full transparency, the VELscope is not the least expensive oral screening technology on the market, so if you are extremely cost-conscious, the VELscope may not be the best fit for your practice. Ultimately, we recommend that all practices do their research into all oral screening technologies, comparing cost, efficacy of the device and a review of clinical research studies to determine which oral screening technology is the best fit for your practice.

As always, we are happy to answer any questions you have and can connect you with a VELscope dealer. Please click the button below or call 877.278.3799.

(Visited 6,481 times, 2 visits today)

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How Much Does the VELscope Cost? - VELscope®

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By Wayne Rees How Much Does the VELscope Cost? The VELscope Vx system is one of the leading technologies for the adjunctive visualization of oral mucosal abnormalities, including dysplasia, oral cancer, infections and trauma.

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Cunha Busquet PD, Jesus Portelinha DD, Da Costa ML, Cancio de Paula VDA (2021) How the myobrace appliance works: Advantages and disadvantages. J Dent Probl Solut 8(1): 019-023. DOI: https://dx.doi.org/10.17352/2394-8418.000098
 
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This article reviews the Myobrace system and goes into depth about the various appliances available for myofunctional therapy.

Advantages to using these appliances include:

Correcting habits such as mouth breathing

Correcting atypical swallowing And incorrect tongue positioning

Helps alignment and leveling of teeth

Use of brackets are not necessary

Correction of dental arch shape

Disadvantages that apply to this treatment include:

Relapse

Less comfort for the patient

The longer the permanent dentition is maintained, the less effective the therapy

Cooperation of the patient

Most effective is primary dentition from age 3

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This is a video that gives a brief overview about Myofunctional orthodontics and details case studies of how it works.

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This is a video by Hygiene Edge that shows a quick demonstration on how the oral cancer screening device by Oral ID works and how they can be utilized to screen patients.

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Bunk D, Eisenburger M, Häckl S, Eberhard J, Stiesch M, Grischke J. The effect of adjuvant oral irrigation on self-administered oral care in the management of peri-implant mucositis: A randomized controlled clinical trial Clin Oral Impl Res. 2020;31:946-958. https://doi.org/10.1111/clr.13638 

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This article is about a randomized clinical trial that evaluated oral irrigation in addition to regular oral care by patients and its effectiveness on peri-implant mucositis. A total of 60 patients that had peri-implant mucositis were assessed during their regular treatment appointments and the authors presented and discussed their findings. They had two groups using water or a 0.06% CHX as a solution compared to a group that did their oral hygiene care without any use of an oral irrigator (Bunk et al., 2020, pg. 951). The authors concluded that using an oral irrigation device on top of mechanical biofilm removal can reduce the presence of peri-implant mucositis after 12 weeks, however they also stated that mechanical debridement is a gold standard in the treatment of the disease as well (Bunk et al., 2020, pg. 955).

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Sarkisova, F., Morse, Z., Lee, K., & Bostanci, N. (2024). Oral Irrigation Devices: A scoping review. Clinical and Experimental Dental Research, 10(3). https://doi.org/10.1002/cre2.912 

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This comprehensive systematic review focused on reviewing oral irrigation devices and gaps of evidence that are needed for further evaluation. The article starts off by an explaining how plaque can induce many different dental diseases, which can lead to problems that can cause a financial burden on patients. They express how these populations struggle with maintaining oral hygiene and how oral irrigators can be an adjunctive aid for at-home care. Tables and figures along with descriptions were used to present data found on the sources they used. Findings were described in different sections throughout the paper and included irrigation with biofilm removal, special needs, endodontics, etc. It was concluded that the oral irrigators can effectively reduce periodontal inflammation, however there was a lack of knowledge on effectiveness of biofilm removal, environmental and economic considerations, and more (Sarkisova et al., 2024, pg. 13).

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Clares, A. (n.d.). Oral irrigator: Benefits and harms of using. Village Dental medicine. https://villagedentalmedicine.com/oral-irrigator-benefits-and-harms-of-using/ 

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This website by Village Dental Medicine overviews what an oral irrigator is, how it can help, and provides information on the benefits and potential harm that is present with using them.

Advantages that were discussed include:

Reaching difficult to reach areas that are not accessible by standard brushing

Massages gums to improve blood circulation and reduces risks of disease

Can be used during times of gum sensitivity such as pregnancy, care for braces, implants, and dentures

Prevention of gingivitis and periodontitis

Ability to choose device that fits individual needs

Disadvantages include:

Current location of irrigator in oral cavity is needed for proper use out of device

Compliance with safety measures

Correct choice of power needs to be implemented

Some contraindications can include chronic bleeding gums, mucosal injury, rosacea, etc.

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This article from the New York Times ranked different oral irrigators, also known as water flossers and compared them to each other. Prices of each one were also listed with the budget friendly option being $37 and the top ranked being $90.

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This video provides a demonstration on how to properly use an oral irrigation device.

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Jampani ND, Nutalapati R, Dontula B, Boyapati R. Applications of teledentistry: A literature review and update. J Int Soc Prevent Communit Dent 2011;1:37-44.

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This literature review defines teledentistry as, “a combination of telecommunications and dentistry involving the exchange of clinical information and images over remote distances for dental consultation and treatment planning” (Jampani et al., 2011, pg.37). This article outlines a basic understanding of teledentistry and its role in different fields of dentistry along with legal and ethical issues and implications for the future. A way for this concept to work involves a videoconference where dental professionals and patients can communicate with each other. This new technology can improve the delivery of oral healthcare, lower costs, and improve access to dental care. Although there are many benefits to teledentistry, concerns arise with it such as confidentiality of private information and legal issues such as licensures, jurisdiction, and malpractice. Teledentistry is an important technological advancement that can impact access to dental care in rural and urban areas where there’s a lack of dental professionals, so bridging this gap can impact those populations greatly.

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Ghai, S. (2020). Teledentistry during COVID-19 pandemic. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(5), 933–935. https://doi.org/10.1016/j.dsx.2020.06.029 

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This article overviews the applications of teledentistry in regards to the COVID-19 pandemic. During the pandemic most dental procedures, unless in an emergency or surgery, were suspended therefore access to dental care was diminished. Teledentistry was a solution that facilitated remote guidance and education of dental treatment through technology rather than face-to-face connection with patients during this time. This article details subunits of the topic and challenges such as lack of acceptance with the dentist and patients. Despite these challenges, teledentistry can incorporate dental practice to those that may not be able to attend face to face.

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Chen, J.-W., Hobdell, M., Dunn, K., Johnson, K., & Zhang, J. (2014, December 29). Teledentistry and its use in dental education. The Journal of the American Dental Association. https://www.sciencedirect.com/science/article/abs/pii/S0002817714640873

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This article overviews how teledentistry can be used for advanced dental education and not just improving access to dental care. Types of studies that were reviewed include self-instruction and interactive videoconferencing. They found that interactive videoconferencing had better results due to immediate feedback rather than self-instruction. The authors also review definitions, history, and use of teledentistry to treat underserved populations at lower costs while providing opportunities for dental students through new teaching methods with this technology.

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Lee, J. (2023, April). Teledentistry in a clinical setting: Advantages and barriers of ... https://vuir.vu.edu.au/46249/1/LEE_Joshua-Thesis_nosignature.pdf 

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This literature review aims to determine the advantages and barriers that teledentistry has in clinical settings using questionnaires and reviewing studies conducted.

Advantages that were listed include:

Delivery of health care remotely leading to an increase in access

High satisfaction rate - viewed as beneficial to most clinicians

Reduced transmission risk during the COVID-19 pandemic

Decreased amount of time patients needed to be in person

Improve communication between patients

Benefiting populations in remote or rural areas

Addressing socioeconomic, geographical, and accessibility issues

(Lee, 2023, pg. 30-31)

Disadvantages that were addressed include:

Initial high cost for setup

Difficulty implementing it in their own practices for dentists

Availability and quality of technology that is required internet such as connection and cameras

Difficulty in the usage of technology for clinicians and patients

Low confidence with diagnosing more complex cases

Inability to conduct tactile examination

Financial reimbursement issues

(Lee, 2023, pg. 32)

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This article outlines various teledentistry services that range from $29 to $299 and whether or not insurance is considered. Each service is also provided with a brief description of what they offer and how they operate.

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The 10 Best Online Teledentistry Services in 2023 - The TeleDentists

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The TeleDentists is a top service provider for virtual dental services. Continue reading to find out more about ‘The 10 Best Online Teledentistry Services in 2023’ here!

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Geisinger, M. L., Mealey, B. L., Schoolfield, J., & Mellonig, J. T. (2007). The effectiveness of subgingival scaling and root planing: An evaluation of therapy with and without the use of the periodontal endoscope. Journal of Periodontology, 78(1), 22–28. https://doi.org/10.1902/jop.2007.060186 

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According to this article, “a fiber-optic periodontal endoscope was developed to aid in the visualization of sublingual structures and to improve the diagnosis and management of periodontal diseases” (Geisinger et al., 2007). This study was conducted to determine if utilizing a periodontal endoscope had an impact on decreasing residual calculus rather than SRP by itself. They analyzed different subjects who were randomized to receive SRP using the endoscope and without using the endoscope. They found that there was a significant reduction in residual calculus with deeper probing depths, but not that much of a difference with shallower depths.

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Geisinger, M. L., Mealey, B. L., Schoolfield, J., & Mellonig, J. T. (2007). The effectiveness of subgingival scaling and root planing: An evaluation of therapy with and without the use of the periodontal endoscope. Journal of Periodontology, 78(1), 22–28. https://doi.org/10.1902/jop.2007.060186 

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This article states, “The periodontal endoscope is used by some clinicians to help enhance access to effectively remove subgingival calculus; however, longer-term studies on this subject are still lacking. The purpose of this randomized, controlled clinical trial was to compare the clinical outcomes of scaling and root planing (SRP) using a periodontal endoscope versus conventional SRP using loupes for up to 12 months, utilizing a split-mouth design” (Wright et al., 2023). Tables and figures were used to discuss data that was retrieved from this clinical trial that mainly focused on periodontally involved teeth. The authors concluded that the use of a periodontal endoscope was significantly beneficial for teeth that were multirooted rather than single rooted teeth. However, it was also stated that using the periodontal endoscope was better than using the traditional explorer alone to detect calculus.

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Ho, K. D., Ho, K. R., Pelekos, G., Leung, W., & Tonetti, M. S. (2024). Endoscopic re‐instrumentation of intrabony defect–associated deep residual periodontal pockets is non‐inferior to Papilla Preservation Flap Surgery: A randomized trial. Journal of Clinical Periodontology. https://doi.org/10.1111/jcpe.14075 

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This article states, “Endoscopic-assisted subgingival debridement (EASD) may enhance the outcomes of repeated instrumentation and provide a minimally invasive non-surgical alternative” (Ho et al., 2024). The main topic of this article is to present the findings from the randomised trial that was conducted to figure out if using an endoscope to assist when debriding was more efficient than papilla-preservation flap surgery (PPFS). They found that EASD had a significantly shorter treatment time than flap surgery and found it to be a minimally invasive alternative compared to surgery for periodontally involved patients.

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Kwan, J. Y., & Newkirk, S. (2017, January 27). Applications and limitations of periodontal endoscopy. Decisions in Dentistry. https://decisionsindentistry.com/article/applications-limitations-periodontal-endoscopy/ 

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This article provides an in-depth review of the applications and some advantages that using a periodontal endoscope may have along with the limitations that it can come with. They also provided multiple case studies with patients that went through treatment using endoscopic debridement.

Advantages and applications include:

-useful for patients who are beginning initial periodontal therapy and individuals who do not respond to traditional nonsurgical periodontal therapy

-Identifying subgingival pathologies such as caries, open restorations margins, cervical enamel projection, root fractures

-Patients that have a contraindication to surgery or refuse surgery

-Microvisual instrumentation and facilitates visualization subgingivally

-Optimizes subgingival healing

-Enlarges image while delivering light and irrigation

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An examination of the use of this technique in nonsurgical periodontal therapy

In 2015, the American Dental Association (ADA) Council on Scientific Affairs released a systematic review and meta-analysis of nonsurgical treatment for patients with chronic periodontitis. The report concluded that conventional scaling and root planing, with or without adjuncts, should be considered the initial treatment modality for patients presenting with this chronic disease. ¹

The primary objective of scaling and root planing is to restore periodontal health by removing pathogenic materials and products (e.g., biofilm, calculus and endotoxins) that induce inflammation from periodontally involved root surfaces. Calculus has been shown to contain bacterial products that contribute to the inflammatory response and can perpetuate periodontal infection. ²⁻⁴ Numerous studies, however, indicate clinical difficulty in determining the thoroughness of subgingival instrumentation, as well as clinical limitations in instrumenting subgingival root surfaces in a closed pocket, particularly in pocket depths greater than 5 mm. ⁵⁻⁸

The periodontal endoscope facilitates visualization of the subgingival environment via a 1-mm-diameter, flexible fiber-optic probe with imaging capabilities (Figure 1). This fiber-optic system enlarges the image while also delivering light to the working field.

In use, the endoscopic fiber is covered with a single-use, sterile endoscopic sheath. ⁹ The disposable sheath provides a barrier to pathogens, preventing cross contamination. The sheath protects the fiber and bonded sapphire lens (housed inside a metal cannula), and is designed to deliver water irrigation, keep the endoscope lens clear, and eliminate the need for disinfection of the fiber between patients.

The fiber/sheath/explorer complex (Figure 2) is placed into the sulcus by the clinician for subgingival viewing. ¹⁰ The real-time video image is displayed on a chairside monitor and may be magnified between 24 and 48 times, depending on the proximity of the fiber-optic lens to the area being viewed. Table 1 summarizes the advantages and disadvantages of this technique.

An early study by Stambaugh et al evaluated the periodontal endoscope and the ability of the clinician to develop skills in using fiber-optics to accurately visualize the contents of the subgingival sulcus. ¹¹ Results from other studies demonstrated that adjunctive use of the periodontal endoscope for nonsurgical periodontal therapy resulted in improved visibility of deposits for calculus removal. 4,12

Wilson et al found that root surfaces treated endoscopically with a single course of closed subgingival scaling and root planing demonstrated no histologic signs of chronic inflammation six months after therapy. ¹³

Clinical Applications of the periodontal Endoscope

Though not a comprehensive list, uses for periodontal endoscopy include:

Patients with probing depths greater than 4 mm who are beginning initial periodontal therapy

Individuals with sites that have not responded to traditional nonsurgical debridement

Periodontal maintenance patients with chronic inflammation or increasing probing depths

Residual probing depths in periodontal maintenance patients who refuse surgical therapy, and/or where surgery is contraindicated for medical or esthetic reasons

Patients with suspected subgingival pathology, such as root fractures, endodontic root perforations or resorption

Other subgingival pathologies identified with this technology include caries, open restoration margins and cervical enamel projection

Endoscopic root debridement is achieved using hand instruments or ultrasonic inserts or tips (UITs); this allows for microvisual instrumentation and optimizes subgingival healing. The following periodontal endoscopic cases are consistent with the 2015 ADA Council on Scientific Affairs recommendations that conventional scaling and root planing, with or without adjuncts, be considered the initial treatment for patients with chronic periodontitis. ¹

Elemental iodine or its derivatives (povidone-iodine) may be the most broad spectrum and potent antiseptics available. ¹⁷ Elemental iodine's broad spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and low cost make it a valuable adjunct to periodontal therapy. ¹⁸

In a 2009 study, Wilson found that excess dental cement was associated with signs of peri-implant disease. ¹⁹ One possible explanation is that cement retains microbes, similar to those responsible for inflammatory periodontal disease, and the rough surface of the cement inhibits the removal of the microorganisms, which can lead to peri-implant disease. The study noted that after removal of excess cement, clinical and endoscopic signs of peri-implant disease were absent at 30 days posttreatment. ¹⁹ A later study found small pieces of cement in the soft tissues, however, which may warrant flap surgery in some cases. ²⁰

Even the most diligent clinicians may sometimes miss residual subgingival cement in implant cases. For this reason, maintenance is extremely important for patients who have cement-retained implant restorations. Signs of peri-implant inflammation often serve as a warning that there is excess cement below the gumline, and alert clinicians before there is radiographic bone loss. Other symptoms can include localized inflammation, progressively deeper probing depths, or bleeding on probing. If these signs are caught early, it may be possible to remove excess cement before irreversible damage occurs. ²¹

The following cases show how endoscopic debridement of an implant with retained cement may resolve once the cement is microscopically removed.

Micro-encapsulated minocycline is a locally delivered drug that the clinician places into diseased sites in the periodontium. The drug releases the antimicrobial at a steady pharmacological level for an extended period. ¹⁴

Case 4: Endoscopic debridement #9 mesial, with adjunctive systemic antibiotic amoxicillin and metronidazole (figures 6A and 6B)
Treatment by Amy Curran, RDH, in the periodontal office of Ronald Watkins, DDS, MS, Phoenix, Arizona

Periodontal lesions often harbor a mixture of pathogenic bacteria. As a result, drug combination therapies have gained increasing importance. In fact, they may even be required for eradication and prevention of periodontal infections by known periodontal pathogens that invade subepithelial periodontal tissue or colonize extra-dental domains - from which they may translocate to periodontal sites. ¹⁵

Antibiotic combination therapy with two antibiotics can be used to take advantage of different mechanisms of action and to expand the spectrum of antimicrobial activity. Amoxicillin-metronidazole (250 mg amoxicillin; 375 mg metronidazole, three times daily for eight days) is the most common antibiotic combination in periodontics. ¹⁶

Elemental iodine or its derivatives (povidone-iodine) may be the most broad spectrum and potent antiseptics available.17 Elemental iodine's broad spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and low cost make it a valuable adjunct to periodontal therapy.18

In a 2009 study, Wilson found that excess dental cement was associated with signs of peri-implant disease.19 One possible explanation is that cement retains microbes, similar to those responsible for inflammatory periodontal disease, and the rough surface of the cement inhibits the removal of the microorganisms, which can lead to peri-implant disease. The study noted that after removal of excess cement, clinical and endoscopic signs of peri-implant disease were absent at 30 days posttreatment.19 A later study found small pieces of cement in the soft tissues, however, which may warrant flap surgery in some cases.20

Even the most diligent clinicians may sometimes miss residual subgingival cement in implant cases. For this reason, maintenance is extremely important for patients who have cement-retained implant restorations. Signs of peri-implant inflammation often serve as a warning that there is excess cement below the gumline, and alert clinicians before there is radiographic bone loss. Other symptoms can include localized inflammation, progressively deeper probing depths, or bleeding on probing. If these signs are caught early, it may be possible to remove excess cement before irreversible damage occurs.21

The following cases show how endoscopic debridement of an implant with retained cement may resolve once the cement is microscopically removed.

key takeaways

A 2015 systematic review and meta-analysis of nonsurgical treatment for patients with chronic periodontitis conducted by the American Dental Association Council on Scientific Affairs concluded that conventional scaling and root planing - with or without adjuncts - should be considered the initial treatment modality for patients presenting with this chronic disease.¹

The periodontal endoscope facilitates visualization of the subgingival environment via a fiber-optic probe. This system enlarges the image up to 48 times, while also delivering light and irrigation to the working field.

Among the clinical applications for the periodontal endoscope are patients undergoing initial periodontal therapy with probing depths greater than 4 mm, and periodontal maintenance patients with chronic inflammation, or increasing probing depths.

Additional subgingival pathologies that can be identified with the periodontal endoscope include caries, open restoration margins, cervical enamel projections, root fractures, endodontic root perforations and resorption.

Endoscopic root debridement via hand instruments or ultrasonic inserts/tips allows for microvisual instrumentation

LIMITATIONS AND CONCERNS

Periodontal endoscopy requires a learning phase in order to become comfortable with the technology. A learning curve of approximately 10 to 30 cases is typically required to feel proficient with image interpretation, implementation of the two-handed technique, and proper patient and operator positioning (Table 2).

Currently, training in periodontal endoscopic debridement techniques can take place in-office using online video review of the technology and instrument placement, bench training for the two-handed technique, and hands-on patient treatment. This type of instruction can be provided in private practices, but may also be implemented as part of dental, dental hygiene and periodontal clinical training.

Instruments are positioned by direct vision into the oral cavity and the operator then focuses on the monitor to govern movements. Medium to medium-plus power is used with ultrasonic instrumentation, using lateral pressure for more power (which is contrary to most teaching, but the benefit is very evident when cleaning endoscopically). More tenacious deposits require more amplitude or ultrasonic power, combined with smaller movements and more pressure over deposits until the area is completely clean.

Periodontal endoscopy utilizes a two-handed technique in which the endoscope is used in the nondominant hand (similar to holding a dental mirror), with the ultrasonic instrument in the dominant hand, moving together around the tooth during instrumentation. Subgingival visualization has shown that instrument access is far more predictable and efficient when the root surface and instrument can be viewed simultaneously. Rarely, a "view, instrument and view" technique is used when both the endoscope and ultrasonic instrument are unable to simultaneously access the area being scaled. Beginning and finishing with one explorer in each segment before starting with another explorer is an integral part of the systematic approach to endoscopic debridement. This methodology is not unlike that taught for blind, closed-pocket instrumentation. ¹⁰

Ultrasonic instruments are the first choice for use with the periodontal endoscope. The most commonly used UITs are small and probe-like. Endoscopically, ultrasonic instruments provide efficient root debridement, and the technique requires a small array of UITs. A full mouth debridement typically requires only a straight, probe-like universal UIT, with an occasional need for curved or angled instruments. These nonbladed instruments are also less likely to remove healthy root structure. Efficiency is enhanced by fewer instrument changes and better instrument adaptation. ¹⁰ A recent study suggests the use of hand instruments when removing cements from implants, however, due to the potential for powered instruments to eject small particles of cement into soft tissues. ²⁰ Ultimately, the choice is up to clinicians' best judgment.

Diamond-coated ultrasonic instruments are used for advanced instrumentation in the removal of rough (globular) cementum, tenacious calculus, overhanging restorations and subgingival enamel anomalies. Because of their cutting power, however, using diamond-coated UITs requires advanced skills. This is not only true when utilizing the cutting function, it's also necessary to avoid damage to the explorer shield, sheath or the endoscope fiber itself. ¹⁰

Visualization with the dental endoscope is sometimes difficult in pockets less than 4 mm because the water clearing the camera lens is not as constant on the tooth surface as it is inside a deeper periodontal pocket. Heavy inflammation may create excessive bleeding and soft tissue tags that may float in front of the camera lens, obscuring visualization. These tissue tags often work loose as sites are debrided and "clear up," and/or can be moved aside with the ultrasonic instrument.

CONCLUSION

Ultrasonic endoscopic periodontal debridement is a minimally invasive microvisual technology primarily utilized for the nonsurgical treatment of periodontal disease. Yet the dental endoscope also has applications for the evaluation of caries, root fractures, root resorption or perforations, residual cement around tooth and implant restorations, and subgingival anomalies. As with any dental instrumentation modality, this technology requires focused attention, training, practice and patience.

The 2015 ADA Center for Evidence-Based Dentistry clinical practice guidelines on the nonsurgical treatment of chronic periodontal disease note that scaling and root planning are still the gold standard for nonsurgical therapy. ²² The periodontal endoscope supports this therapeutic approach, and has been found to be a minimally invasive technology that provides visualization with magnification and illumination within a closed pocket to aid in the diagnosis and treatment of chronic periodontitis and peri-implant disease.

References

1. Smiley CJ, Tracy SL, Abt E, et al. Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc. 2015;146:508-524.

2. Allen DL, Kerr DA. Tissue response in the guinea pig to sterile and non-sterile calculus. J Periodontol. 1965;36:121-126.

3. Tan BKT, Mordan NJ, Embleton J, Pratten J, Galgut PN. Study of bacterial viability within the human supragingival dental calculus. J Periodontol. 2004;75:23-29.

4. Blue CM, Lenton P, Lunos S, Poppe K, Osborn J. A pilot study comparing the outcome of scaling/root planing with and without Perioscope technology. J Dent Hyg. 2013;87:152-157.

5. Rabbani GM, Ash MM, Caffesse RG. The effectiveness of subgingival scaling and root planing in calculus removal. J Periodontal. 1981;52:119-123.

6. Caffesse RG, Sweeney PL, Smith BA. Scaling and root planing with and without periodontal flap surgery. J Clin Periodontol. 1986;13:205-210.

7. Sherman PR, Hutchens LH Jr., Jewson LG, Moriarty JM, Greco GW, McFall WT Jr. The effectiveness of subgingival scaling and root planing. I. Clinical detection of residual calculus. J Periodontol. 1990;61:3-8.

8. Stambaugh RV, Dragoo M, Smith DM, Carasali L. The limits of subgingival scaling. Int J Periodontics Restorative Dent. 1981;1:30-41.

9. Perioscopy System Operators Manual, Page 6. Danville Materials, LLC, a division of Zest Anchors, LLC.

10. Harrel SK, Wilson TG Jr., eds. Minimally Invasive Periodontal Therapy: Clinical Techniques and Visualization Technology. Hoboken, NJ. Wiley-Blackwell. 2015.

11. Stambaugh RV, Myers G, Ebling W, Beckman B, Stambaugh K. Endoscopic visualization of the submarginal gingiva dental sulcus and tooth root surfaces. J Periodontol. 2002;73:374-382.

12. Osborn JB. Role of the dental endoscope in calculus detection. Dimensions of Dental Hygiene. 2016;14(2):40,42-44.

13. Wilson TG Jr., Carnio J, Schenk R, Myers G. Absence of histologic signs of chronic inflammation following closed subgingival scaling and root planning using the dental endoscope: Human biopsies - A pilot study. J Periodontol. 2008;79:2036-2041.

14. Wilder RS. A new option for local delivery. Dimensions of Dental Hygiene. 2003;1(2):24-27.

15. Slots J, Ting M. Systemic Antibiotics in the treatment of periodontal disease. Periodontal 2000. 2002;28:106-176.

16. Slots J. Selection of antimicrobial agents in periodontal therapy. J Periodontal Res. 2002;37:389-398.

17. Kotsilkov K, Emilov D, Popova CHR. Subgingival Irrigations With Povidone-Iodine as Adjunctive Treatment of Chronic Periodontitis. Journal of IMAB - Annual Proceeding (Scientific Papers). 2009;book 2. Available at: journal-imab-bg.org/statii-09/vol09_2_84-88str.pdf. Accessed July 7, 2016.

18. Hoang T, Jorgensen MG, Keim RG, Pattison AM, Slots J. Povidone-iodine as a periodontal pocket disinfectant. J Periodontal Res. 2003;38:311-317.

19. Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009;80:1388-1392.

20. Wilson TG Jr., Valderrama P, Burbano M, et al. Foreign bodies associated with peri-implantitis human biopsies. J Periodontol. 2015;86:9-15.

21. Hughes K. Implant Failures Caused by Cements. Inside Dentistry. 2013;9(2). Available at: dentalaegis.com/id/2013/02/implant-failures-caused-by-cements. Accessed July 7, 2016.

22. ADA Center for Evidence-Based Dentistry. Nonsurgical Treatment of Chronic Periodontitis, Clinical Practice Guideline 2015. Available at: ebd.ada.org/en/evidence/guidelines/nonsurgical-treatment-of-chronic-periodontitis. Accessed July 7, 2016.

From Decisions in Dentistry. August 2016;2(08):10-14.

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dental continuing education frequently asked questions

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Applications and Limitations of Periodontal Endoscopy - Decisions in Dentistry

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Decisions offers evidence-based peeer-reviewed continuing education courses written by world class educators and researchers

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Kwan, J. Y., & Newkirk, S. (2017, January 27). Applications and limitations of periodontal endoscopy. Decisions in Dentistry. https://decisionsindentistry.com/article/applications-limitations-periodontal-endoscopy/ 

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Limitations and disadvantages are:

-Learning phase required to become comfortable with technology, about 10 to 30 cases

-Anatomical considerations

-Instrument access

-Difficulty in visualization when pockets are less than 4mm

-Excessive bleeding and soft tissue tags with heavy inflammation may obstruct the view

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This article by RDH mag provides useful information about how periodontal endoscopes are impacting dentistry. It was also mentioned the amount to expect when wanting to purchase one. Lynne Slim states “New customers have been buying equipment at the $2,500 to $3,000 price point. Disposable Perioscopy sheaths are just under $50 each and are not reusable. The sheath protects the fiber and also conveys water to the end of the fiberoptic camera. Perioscopy fibers are over $1,400 and tend to last from 50 to 70 uses. Perioscopy explorers are $85 each, and with appropriate technique and instrumentation need replacement infrequently” (2011).

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This video discusses what a teledentistry appointment can look like.

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This quick video shows what can be seen when using endoscopic instrumentation.

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The Periodontal Endoscope (or "Perioscope")