Perioscopy and ultrasonic efficiency

April 1, 2011
Proverbs are short, meaningful sayings that express a basic truth. I have many favorites such as this one: ...

by Lynne H. Slim RDH, BSDH, MSDH
[email protected]

Proverbs are short, meaningful sayings that express a basic truth. I have many favorites such as this one: "The more things change, the more they stay the same."

Why is it that medicine has embraced endoscopy and dentistry lags behind, especially when we now have the ability to scope into deep pockets? John Y. Kwan, DDS, president and CEO of Perioscopy Inc., is a champion of this voyage to find a minimally invasive way to visualize the subgingival pocket environment.

John and his hygiene team have embraced this technology, and he shares his passion with RDH readers.

How many clinicians around the United States are currently performing Perioscopy?

We have more than 70 offices with Perioscopes that are buying disposable sheaths, and that gives us an indication of the amount of activity in the United States and abroad.

Of those, about half are doing procedures regularly. The other half seem to be dabbling in the technology, using it infrequently or only for diagnostic purposes.

How does Perioscopy enhance root debridement, and what bothers you most about clinicians who are working blindly?

Root debridement is more predictable when the root is visualized. That is the primary rationale for periodontal surgery.

The Perioscope allows for root debridement in a very minimally invasive microvisual way and this can be done by dentists and hygienists (without an assistant).

We have plenty of evidence to support the lack of effectiveness when providing root debridement blindly. What bothers me is that this effort is generally accepted as the standard of care for initial therapy.

Since you haven't debrided root surfaces "blindly" in more than nine years with the endoscope and almost 30 years surgically, which ultrasonic technology do you prefer and why?

25K magnetostrictive micro ultrasonic instrumentation is what we use. This technology is easiest to change inserts, very versatile, very effective, and allows us to provide full-mouth treatment in one appointment.

The majority of our treatment is done with one instrument (99% with one instrument).

For hygienists who want to improve ultrasonic efficiency, what suggestions can you offer them?

I recommend adopting a "growth mindset." A growth mindset looks at learning as a process, which may include small "failures" along the way but realizes that this is a journey toward a goal.

The opposite, or "fixed mindset," looks at new things and challenges differently. If the success does not come easily or immediately, the "failure" is the deal breaker.

Have you ever embraced piezoelectric technology and if not, why not?

I have tried more than 30 ultrasonic brands and types, both magnetostrictive and piezo, manually tuned and automatically tuned. The piezo tips are not easily changed. They are small and easily lost, require a separate wrench to place, are expensive, and are not recyclable.

Both technologies clean well endoscopically, but we know bladed and diamond ultrasonics are very aggressive and piezo companies advocate them for tactile (blind) debridement.

Do you ever use hand instruments (curettes) while performing debridement, or do you use ultrasonics exclusively?

Hand instruments are very inefficient with or without the Perioscope. We use ultrasonics exclusively endoscopically.

Where can a hygienist purchase a periodontal endoscope, and how much can he or she expect to pay for one? Also, what's the overall maintenance cost, including parts?

Currently, only preowned equipment is available. That said, they are typically unused. 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.

It is rare for a hygienist to purchase a Perioscope as the business side of practice is typically not part of the practice of dental hygiene.

That said, there are several hygienists who have been able to work it out so that they use their Perioscopes, although it has not been easy for them.

What's it going to take for Perioscopy to become a mainstream technology for periodontal debridement?

Currently, this technology seems to be for "early adopters" only. When you look at how long it is taking for the adoption of micro ultrasonics, digital X-rays, and even computers, Perioscopy is a long, long way from being mainstream.

I estimate that there are less than 10 qualified teachers actually using the Perioscope in treatment, who are involved with teaching. I think the "tipping point" will be 100 teachers of this technology. We will continue to push this technology forward and help anyone who wants to follow "healing through a better vision."

Author's note: You can reach John at; he welcomes your queries.

Lynne Slim, RDH, BSDH, MSDH, is an award-winning writer who has published extensively in dental/dental hygiene journals. Lynne is the CEO of Perio C Dent, a dental practice management company that specializes in the incorporation of conservative periodontal therapy into the hygiene department of dental practices. Lynne is also the owner and moderator of the periotherapist yahoo group: Lynne speaks on the topic of conservative periodontal therapy and other dental hygiene-related topics. She can be reached at [email protected] or

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