Periodontal Therapy 

Deep Pocket Therapy with New Attachment™ using the Waterlase MD™ and Radial Firing Perio Tip™

 augmented with Arestin (Minocycline microspheres)

The Radial Firing Tip

The Root, Gingiva and Radial Firing Tip   Radial Firing Tip Action Enlarged

Background: 

 In areas of periodontal pocketing deeper than 4 or 5 mm, we understand that the bacterial mix shifts toward more anaerobic bacteria since less oxygen can get into the deeper pocket between the gingiva (gum) and the tooth root. The epithelium attachment to the tooth has also migrated down and the root surface is contaminated with bacteria, their waste products and hardened calculus that strongly adhere to the root surface and prevent the gum from attaching to the root. This inflammation of the gingiva leads to less healing and more resorbtion of the bone that supports the tooth with the results that the pockets get deeper with time, along with more bone loss, tooth mobility and ultimately loss of the tooth from periodontal disease.

The Protocol used:

1. Measure the pockets with a periodontal probe and review xray images of the area.
2. Use conventional hand scalers and ultrasonic scalers to remove as much calculus (hard tartar) from the tooth and roots as possible.
3. The radial firing periodontal tips with the Waterlase MD is introduced into the periodontal pocket and, with a sweeping motion, the base of the pocket is sterilized (the laser activates and vaporizes tiny areas of water and since the bacteria are mostly water they individually explode) and the waste products are flushed out at the same time by the gentle flow of water and air.  
4. As the sweeping motion is continued and the tip is slowly withdrawn the infected epithelium lining is dissolved on the tissue side of the pocket and the root is cleansed of calculus, bacteria and their toxins.
5. In order to prevent re-epithelialization of the pocket wall, the surface epithelium of the gingiva is laser de-epithelialized for 3-4 mm.
6. This procedure is sometimes combined with Localized Antibiotic Therapy in the form of placing Arestin (minocycline 1 mg of microspheres) into the treated periodontal pocket to ensure prolonged anti-bacterial effect and induce soft tissue adherence to the cleansed tooth root and filling of the periodontal defect with bone. 
   
   The bite is evaluated to reduce any local trauma from the occlusion (bite).

The use the Biolase Waterlase MD laser combined with Arestin placement with more advanced periodontal pockets in this combined approach:

• is minimally invasive,
• removes the diseased tissue,
• gives less trauma to the healthy tissue,
• maintains the height of the tissue around teeth,
• minimizes pain and discomfort to the patient,
• gets a closure of the periodontal pocket wound and,
• allows more rapid healing to take place than with open flap periodontal surgery.