johnkwan
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Tuesday, September 01, 2009
Featuring: BioHorizon's AlloDerm, Hu-Friedy Serrated Scissors, 5.0 Chromic Gut Suture, Hartzell Fine Diamond Coated Microsurgery Pickups
link
johnkwan
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Friday, July 31, 2009
I just received this article from Drs. Luigi Cecchi and Maro Montvecchi from the University of Bologna.
The Relationship between Bleeding on Probing and Subgingival Deposits. An Endoscopical Evaluation link
JKwan, Pres/CEO Perioscopy Incorporated
Diplomate of the American Board of Periodontology
Associate Clinical Professor, UCSF School of Dentistry
johnkwan
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Thursday, July 02, 2009
Featuring: papilla sparing single flap access, Gerestore, Sable N6900 Nordland Blade, fine diamond, surgical length fluted cone, surgical length end cutting burr, 6.0 gut modified interrupted suture
link
johnkwan
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Wednesday, June 24, 2009
I had a visit today from my Patterson reps and Jeff Clark from Shick. I thought it was nice that they stopped by because they know I have Dexis, which I love. Dexis has a "Clearview" mode that really enhances the information from an x-ray. Schick has an HD sensor, CDR Elite, that gives you a similar "amped" image without need for "Clearview" modification. I like the fact that Dexis has only one sensor but the Shick #2 flim sized sensor gives you a notably bigger image as it covers more area with no cutting out at the corners. Their pricing and maintenance fee is lower than Dexis and they have a trade in option as well. link
I am probably not going to change because Dexis works so well with my office software, AlphaDent, but I'm really glad the reps came by! The real pearl I got today (besides my favorite roast duck dish at the Thai place across the street) was info about iPan. iPan is a digital retrofit for an existing panoramic xray unit. You don't have to buy a new pan or permanently alter your existing one!!! link
I guess if I get that pan retrofit the lunch wasn't quite free. But that said the retrofit sure beats the cost of a digital pan so they saved me quite a bundle!!!
Thanks for lunch guys!!!
johnkwan
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Wednesday, June 17, 2009
Featuring: Physics Forceps, bone graft putty, Trutaine retainer, .020 vinyl surgical stent
link
johnkwan
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Wednesday, April 08, 2009
I examined a patient today who found our practice in Consumer's Checkbook. She started looking around because her dentist said she needed a $2000 deep cleaning among other restorative work adding up to much more. She suspected she was getting more than she needed.
Her examination revealed a normal periodontium and in spite of not having a cleaning in over 18 months, she "needed" only a prophy. I was so happy that she took her suspicion to the next step, looked for a second opinion and found us on some independent referral source. I had never heard of Consumer's Checkbook, but I am glad that others feel good enough about our practice to offer unsolicited endorsements to others!
I am saddened as well because dentistry, a trusted profession has examples that put trust to the test. I can only pray that practices like these realize that no one really wins when patients are seen as dollar signs.
Malcolm Gladwell's book Blink, Think Without Thinking proved to be right on when our patient had the feeling something was not right. We don't realize how smart our "gut" really is, and yet we often trust it don't we?
johnkwan
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Wednesday, April 01, 2009
Check out this video featuring: Physics Forceps, Immediate Implant, Repair of Apical Fenestration, Intra-Operative Stent Modification and Flapless Implant Placement. Click on LINK, below.
link
johnkwan
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Tuesday, March 24, 2009
Microsurgical Repair of Root Resorption with Gerestore
link
johnkwan
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Wednesday, March 04, 2009
Jodi is training with the Perioscope. The comments at the end of the clip are right on! link
Dr. Phil Hornseth and Jodi Van Egeren, RDH train on the Perioscope: link
johnkwan
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Sunday, March 01, 2009
As President/CEO of Perioscopy Incorporated and as an Assistant Clinical Professor at UCSF I get the opportunity to train dentists, periodontists and hygienists on the Perioscope. This weekend I spent 2 days training Dr. Phil Hornseth and 2 of his hygiene staff, Jodi Van Egeren and Sue Zubella. It was exciting for me to see how well they did and as well for them because they have been wanting this opportunity to provide Perioscopy services for a long time. They found a used (barely) Perioscope from a doctor in Chicago, got the water modification, watched all our videos on our website, then we went through some didactic and bench training, and played the Wii (left handed) while we got going on patient treatment where they started off running with the 2 handed technique. It really helped that they are already using tunable magnetostrictive micro ultrasonic instruments. Our training methods have come a long way and both they and I feel that they are well prepared to begin this exciting journey for their practice, their patients and the community. Congratulations to the first office to be providing Perioscopy services in the state of Wisconsin!
johnkwan
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Thursday, February 19, 2009
Immediate Implant and Provisional with Repair of Apical Fenestration link
johnkwan
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Friday, February 13, 2009
Today I removed #20 that was fractured at the gingival margin with the Physics Forceps. Because the root was fairly short and conical it took less than one minute!!!! Had I not had the Physics Forceps it would have been much more difficult with possible/probable sectioning and more trauma. Check out these cases link
johnkwan
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Friday, February 06, 2009
I saw a patient today who had an 11mm pocket on the facial of #12, as well as some 5-7mm pocketing on the UR molars. Surgery? No, endoscopic debridement with adjunctive Zithromax and also Arestin for #12. 3 months later: UR all wnl probing 3-4mm, #12 probing 7mm. Surgery? No, continued Supportive Periodontal Treatment. 1 year later, #12 probing 5mm. Surgery? No, continued SPT. 15 months later: #12 probing 2mm on the facial. Today all probings are 2-3mm with a couple of 4s. Back to referring dentist for continued SPT at 6 month intervals. Disclosure: I am President/CEO of Perioscopy Incorporated as well as a user of the technology for over 7 years now link. I also teach periodontal endoscopy to first year perio grads at UCSF and provide training to offices that have Perioscopes.
johnkwan
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Wednesday, February 04, 2009
Options for recession: do nothing, get a new President, become a dentist, buy low...
Actually the options for gingival recession are: do nothing or grafting. Grafting either prevents more recession, restores lost tissue or both. AlloDerm is a reasonable option for many situations. Watch this short video to see how it works: link
johnkwan
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Wednesday, January 28, 2009
This patient had some splinted restorations on #7 and 8 that were mobile and repeatedly coming off. This video shows how she transitioned with immediate implants and immediate provisionals. link
johnkwan
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Friday, January 23, 2009
Last night while Deborah, my lovely wife was at her "Shoulda, Woulda, Coulda Book Club" I had a nice glass of Malbec and made this video on Root Coverage Connective Tissue Grafting.
link
johnkwan
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Thursday, January 22, 2009
I have used the VELscope for over a year now link. Fortunately, I have not found anything bad, but I need to keep looking. I like to know that when I am looking at lichen planus, hyperkeratosis or anything unusual that these sites are VELscope negative. I use the VELscope as a routine part of my initial and periodic exams, as well as when our hygiene staff has identified something suspicious. We are not charging extra for it but my return on investment is not measured in dollars. As Fred Joyal of 1800DENTIST mentioned in his last post: establishing trust is key. I feel that honesty and trust are why we continue to be as busy as ever. We recommend treatment instead of selling dentistry. Another reason we remain busy is that we have embraced things that distinguish our practice, such as micro ultrasonics, periodontal endoscopy, microsurgery, IV sedation and the VELscope. BUT that said it never hurts to be caring and SMILE!
johnkwan
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Tuesday, January 13, 2009
Yesterday I had a patient who had a multi-unit bridge and #6 and 7 were so decayed there was no attachment to the crowns left. Leaving only the roots, the plan was to remove them and graft the sites. Immediate implants were considered but #6 had a 23mm root!! Trying to apically stabilize an implant would have been problematic since our system's longest implant is 16mm.
SO, consider getting out a 23mm cuspid root with 2 curves mid root and a fat apex. Along comes the Physics Forceps. After levering on that for about a minute the tooth was loosened and I used some A-Titan forceps to remove the root. I checked the ext socket and noted the very thin facial plate was intact with only a small craze line. MADE MY DAY!
Note: I use the Physics Forceps to LOOSEN teeth. I DON"T use them to REMOVE teeth. Especially when I don't want to compromise the facial bone; which is pretty much all the time...
link
johnkwan
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Saturday, January 10, 2009
I gave an all day talk in Red Bluff yesterday. To the north you can admire the snow capped peaks of Mts Lassen and Shasta, and what an awesome sunset on my drive home to the Bay Area! In additon to talking about microsurgery, micro ultrasonics and non-surgical adjuncts I reviewed our experiences with Perioscopy (and yes I am the Pres/CEO of Perioscopy Inc.). On my drive home I realized that this has and will become a very specialized part of periodontics and dental hygiene as well.
One attendee, a former rocket scientist turned dentist queried about why it would not make sense to have an ultrasonic attached to the camera so that one-handed treatment could be achieved. The concept of "camera separation" is inherent in endoscopy because in medicine and dentistry by keeping the "looker" separate from the "doer", you are allowed to look with the "same" camera into different spaces and separately use different instruments for your treatment needs. Ultrasonics attached to the "viewing" instruments or Perioscopy Explorers, create so much vibration that you cannot see what you are doing (early prototypes bore this out). So you end up viewing, instrumenting and viewing after the ultrasonic is off. Compounding that concept is the need for a custom viewing instrument for every shape ultrasonic you may want AND for the various shapes to be attached to the 4 explorers that get us around the teeeth subgingivally. A logistical and fabrication nightmare.
Consider the fact that while it would be nice to do everything with one hand using the Perioscope, that is looking AND doing, when we are examining and treating patients we are using both hands all the time. AND how much more efficient are we when utilize our great assistants for 4 handed dentistry?! My point is that periodontal endoscoy is a 2-handed procedure. When you try to use just one hand the process slows down significantly and you wouldn't think of looking in the dental mirror, then blindly cutting your prep and then looking again, would you?
The most efficient method is to look with one hand, do with the other hand. In our practice we use micro ultrasonics only, straight, curved right and left shapes and duplicate shapes that are diamond coated. We use these to microvisually remove calculus, soft tissue, globular cementum, caries, amalgam, composite and enamel. Perioscopy allows us to be looking at what we are doing instead of only "feeling" what you are doing. Subgingivally, using visual and tactile input will always be superior to tactile input alone.
Just like it is only with lots of practice that you can become proficient with video games such as Super Mario or Madden, "playing" Perioscopy requires tremendous coordination of not only the eyes and hands BUT the feet as well. So like I said, this technology has and will become a very specialized part of periodontics and dental hygiene. A very rewarding part of periodontics and dental hygiene for our patients AND for our providers!
johnkwan
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Thursday, December 18, 2008
I have been using a variation of their product for over 10 years. Back in the day they used to make DynaFil which was a mineralized cortical powder in a gel or putty. After they stopped making that to make Orthoblast I ended up having to make my own. The problem I had with Orthoblast was the cancellous particles. Some of them are quite large. Mineralized cancellous particles go through a radiolucent phase as well. I have found that mixing DynaGraft D (a demineralized product; too mushy) with mineralized cortical powder gives me a very predictable graft that is stable in extraction sockets without closing, covering or using membranes. I sure wish they would make DynaFil again!!! Most of us know that demineralized freeze dried bone works better in hamster calvaria but mineralized freeze dried bone works better in humans. AND since my hamster practice is virtually non-existent, well you get it.
Check here to see how my "putty" handles: link
There are also other videos utilizing this "bone cocktail" on YouTube Channel: periEau
johnkwan
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Friday, December 12, 2008
I have added some interesting new articles on my Perioscopy Incorporated website.
#1 an article reviewing Laser Decontamination studies, basically concluding that lasers don't do much as an adjunct (NOTE this article does not refer to the LANAP procedure, which in my opinion still remains controversial)
#2 an article by Dr. Tom Wilson showing inflammation in the pocket lining adjacent to calculus
#3 another article by Dr. Tom Wilson showing histologic evidence of absence of inflammation post Perioscopy
link Perioscopy Incorporated
Disclosure: JY Kwan, DDS, DentalCompare Perio Editor, Pres/CEO Perioscopy Incorporated
johnkwan
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Wednesday, December 03, 2008
I saved my notes from an ADA meeting talk by Stephen M.R. Covey (the 7 Habits' son). He mentioned that low trust is everywhere as only 34% of Americans believe other people can be trusted. Here are some of his comments.
The MYTH: trust is a soft nice social virtue
The REALITY: trust is a hard edged economic driver
The MYTH: trust is slow
The REALITY: nothing is as fast as the speed of trust
The MYTH: trusting people is risky
The REALITY: not trusting people is more risky and results in inefficiencies
The MYTH: you can't teach trust
The REALITY: trust can be both taught and learned
Trust is the currency of our business. Globally it is the critical leadership competency.
When Stephen asked the audience, "who do you trust?", the room was silent except for a small voice in the back who said: "GOD". I was somehow compelled to say something...
link
johnkwan
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Friday, November 21, 2008
AND yes I am President/CEO of Perioscopy Incorporated...
That said I have just submitted a book proposal to Wiley-Blackwell on Periodontal Endoscopy. This ia a project that will take the next year but I have plenty of help and inspiration, from my mentor, Tricia O'Hehir,RDH!
I had 2 hygienists visit this week to observe. One from St. Maarten in the Caribbean and one from Chicago. Beth Mierzwa, RDH from Chicago has just purchased her own Perioscope and is going to be the next best thing for the Chicago area! I continue to get inquiries about the technology and the most recent one came from Professor Marian Vladimir Constantinescu, D.D.S., Ph.D., General Manager of Bucharest Dental University Hospital, in Romania!
Not everyone wants to "see it" but they are taking the blinders off everywhere...
johnkwan
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Thursday, November 20, 2008
With the techniques that we have for root coverage grafting via connective tissue, coronal positioning and AlloDerm grafting we don't do gingival grafting with much frequency. However, this case that can be seen on YouTube: link is a simple way to augment the keratinized band and stabilize areas with advancing recession.
This patient had a small segment of gingival grafting done at another office and we were asked to complete the treatment for the rest of the lower anterior.
johnkwan
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Wednesday, November 12, 2008
At Perioscopy Incorporated (read my office) we have been testing diamond ultrasonic prototypes for the past 6 months. I think we have come up with a very usable set and I seem to be using them with direct vision as much as with the Perioscope.
The other day a patient had a large amalgam overhang, supragingival that was easily plastied/marginated with the diamond ultrasonics. This was done under mirror vision with 3.8X Orascoptic Loupes and illuminated with the SheerVision Infinity Ultralight.
Last week I made a video of the use of diamond ultrasonic instruments marginating some composites under microscope vision, 6-10x with coaxial halogen lighting.
To see how they work watch YouTube video: Correction of Poorly Fabricated Dental Restorations
http://www.youtube.com/watch?v=ruHIjPjGno0 (copy and paste)
Or find the same video on ICYOU, DentalTown or HygieneTown.
johnkwan
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Sunday, November 09, 2008
Mucogingival defects can either be watched or grafted. Root coverage restorations are done and can be a reasonable option as well. Root coverage by AlloDerm grafting is portrayed in this short video on YouTube. You can also find this short on DentalTown, HygieneTown and ICYOU.
ICYOU is a health oriented version of YouTube. Check it out!
AlloDerm Root Coverage Grafting: http://www.youtube.com/watch?v=3hR4Fq0Mpxo
johnkwan
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Tuesday, November 04, 2008
OK, this is my last entry about the Academy of Microscope Enhanced Dentistry (for now). Dr. Jean Wu is a prosthodontist who has been around the world and ended up at the Newport Coast Oral Facial Institute with Dr. Cherilyn Sheets and Dr. Jacinthe Pacquette. She gave a wonderful presentation: "Meeting the Demands of Today's Esthetic Restorative Practice". If you get a chance to learn from her, take advantage of the opportunity. She teaches a 2 day workshop on "Introduction to Dental Microscopy" at the NCOFI. I have taken a microsurgical course there with Dr. Peter Nordland and this facility, faculty and education is "world class". Plus what's not to like about Newport Beach, California? If ever there was the "Charlie's Angels" of dentistry the trio of Sheets, Pacquette and Wu are a hit with the best in educating us on form, function and esthetics!
johnkwan
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Monday, November 03, 2008
The Academy of Microscope Enhanced Dentistry meeting featured Dr. Assad Mora's, MoraVision. This is a stereoscopic microscope that you can angle into the mouth and then view a monitor with 3D glasses to see your images in 3D vs 2D which is your typical monitor image.
The system shown has 2 monitors, one at the foot of the patient so the doctor can work in magnifications from 2x-40X and there is another monitor opposite the assistant for viewing in 3D also. Magnifications and focus are adjusted with a foot pedal.
The monitors are very unique. Picture a flat screen monitor with another one laying on the table in front of it. These two monitors are in a box frame with a 45 degree frame between the two. This frame holds a polarizing lens that allows for 3D viewing. I wish I was able to attach a picture to this blog but we are not quite there yet and MoraVision is still working on their website.
I got to "test drive" this technology and it is very cool. I don't think I'm going to replace my microscope but this very high end technology is part of Dr. Mora's "vision" for dentistry and he definitely has an "eye for the future".
johnkwan
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Friday, October 31, 2008
The Fairmont Princes Hotel in Scottsdale is just beautiful this time of year and it is certainly a very nice place to have a meeting! This morning I saw an awesome presentation by Dr. Peter Nordland and Dr. Adriana McGregor, both periodontists from southern California. They were discussing the predictability of papilla regeneration and it is nice to see how, with the right surgical prinicples, instrumentation and definitely with the aid of the operating microscope the papilla in the esthetic zone can be augmented. I have been using Peter's techniques as well and although I don't do as much of this type of surgery as he does, I have been getting nice results as well. Dr. McGregor showed some very nice evidence based information regarding just how much the microscope and microsurgical instrumentation can make a difference in healing. She showed a study that evaluated inflammatory markers during healing with incisions made with a 15C blade vs the blade breaker. Inflammation post healing is greatly reduced at one week with the blade breaker incision vs the 15c incision. This is because the healing process is much more rapid with a precise incision. FYI, the blade breaker is the original radial keratotomy knife.
Much more to come about this fascinating meeting!
[www.microscopedentistry.com]
johnkwan
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Wednesday, October 29, 2008
Renee Marchant-Turner, RDH, does a workshop that teaches new applications to update yesterday's technology and techniques. Her seminar is limited to 6 participants and allows you to gain knowledge actively, by doing, receiving and observing. You can test-drive new machines, inserts and evacuation techniques and then benefit from instant feedback. For more information on her course in the beautiful Napa region of California check out her website: www.handsonhygiene.com. Combine this course with staff or friends and enjoy some Cali wines and fine dining!!
johnkwan
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Sunday, October 19, 2008
This recent upload on YouTube is a short that features the use of the Physics Forceps, a custom bone grafting putty and transition with a Trutaine retainer.
http://www.youtube.com/watch?v=eiV6pCzRoyY
Hope you get a chance to view it. It is also posted on HygieneTown.
Check YouTube Channel: PeriEau for more videos on periodontal and implant microsurgery.
johnkwan
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Tuesday, October 07, 2008
The hypnosis blog was very interesting. I think back to my days at USC and some of my professors who weren't teaching hypnosis were pretty good at putting us to sleep!!
I saw a patient today on referral to evaluate an implant on #11 that had been in place for over 15 years. #11 had some crestal loss to the 2nd-3rd thread back in 2003 when I last saw him. More recently his xray shows the same level with some additional cupping horizontally. Probings are 2-5mm which is wnl, but on the palatal there is some bop and slight exudate.
Exudate is not the bad guy everyone thinks it is. It's just white cells. However, it does indicate there is some inflammation. I will recheck him in 2-3 weeks after he has a chance to run the rubber tip subG on the palatal. I don't usually recommend a rubber tip in the anterior but on the palatal it shouldn't work to blunt the papillae like I have seen with some patients using the rubber tip, tooth picks or the perioaid.
The past 2 weeks in Italy was just awesome! I had a chance to visit with Professor Luigi Checchi from the University of Bologna. He has the only Perioscope in Italy. They are using it mostly to look vs treat but that will come in time. I also had many chances to excite my taste buds with all that pasta, salumi, prosciutto, gellato and of course vino! Buonissimo! I had some delicious wierd food too like: tripe, squid, cuttle fish, culatello, and schwienhaxen (one night in Munich).
Back to work and now on a diet... ;J
johnkwan
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Monday, September 15, 2008
For Perioscopy Incorporated I have been working with the Tony Riso Company and we have made prototypes of diamond coated ultrasonic inserts. These are for cutting endoscopically BUT I have found uses for them for some other procedures:
Root Plasty -
Today I saw a patient who had real matty supragingival plaque in the lingual furcation of #18. After cleaning it out with standard micro ultrasonics I noted that it was cavitated but there were no probable caries. I wanted to smooth this for better OH and used the straight diamond to accomplish this very easily. I then painted the surface with Durafluor, fluoride varnish.
Overhanging Composite Margin -
Last Friday I saw a patient who had a new class V composite that extended to the distal. The distal gingival margin was overhanging almost a half millimeter. I got the straight diamond ultrasonic and gently plastied this to a flush margin.
Cavity Preparation -
The other day a patient had caries on #4D, his terminal abutment. I used the diode laser to clear the gingival margin and used the straight micro ultrasonic diamond to create a prep and then placed Gerestore. The margins were finished with the ultrasonic instrument as well. I found that it was easier to access the tooth with the ultrasonic than it would have been with the handpiece.
So we designed these instruments for endoscopic use but have found some other uses for them that makes them all that more valuable!
I'll let you know when they are available for purchase.
johnkwan
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Saturday, September 13, 2008
As usual the Annual Scientific Session of the American Academy of Periodontology was a great event for me. I was especially blessed with the opportunity to share some information about periodontal endoscopy and some preliminary results of a retrospective case series of 270 patients treated with the micro visual subgingival endoscopic debridement and adjunctive antibiotics. Dr. Parker Workman and I will be working on a formal paper in the near future.
In addition to the AAP meeting I will be reviewing our preliminary data at the CDA meeting tomorrow in San Francisco and also at the California Dental Hygiene Association meeting in Redwood City, CA on October 25.
I would like to make mention of attending a great presentation by my microsurgery mentor, Dr. Dennis Shanelec, the father of periodontal microsurgery. He so exquisitely showed us how he corrects mucogingival problems that result in soft tissue changes after implant placement, particularly in the esthetic zone. He also showed us how he prevents this in his own cases. If you ever get a chance to see Dennis you will be impressed by how he has taken periodontal and implant treatment to the highest level. He is the featured speaker at the Academy of Microscope Enhanced Dentistry in Scottsdale, AZ, Oct 30 - Nov 1. I for one will be there taking notes!!
johnkwan
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Saturday, September 13, 2008
Having blogged about my exposure to one LANAP case I have caused some level of controversy and I am truly sorry. I hope that this post will help diffuse the situation.
The fact that I saw a poorly cleaned root surface subgingivally with the periodontal endoscope does not implicate the LANAP as a procedure that is not worthy of consideration. The fact that I did see a poorly cleaned root surface does indicate that if you do not clean a diseased root to a biologically acceptable level the periodontium has a hard time healing.
This example of inadequate root debridement is just one example. The fact that it was reportedly associated with the LANAP procedure was coincidental and I certainly admit that there are MANY instances where inadequate root debridement results in a poor or marginal response by the host which do not include the LANAP procedure, especially where one cannot see the root surface.
Again as President and CEO of Perioscopy Incorporated, I have a bias toward our technology and as a full time private practicing periodontist I have a bias toward visually cleaning diseased roots. In our practice we just prefer the minimally invasive option using subgingival micro visual technology (www.perioscopyInc.com).
My sincere apologies to the LANAP community and to Millenium Dental Technologies for any misundersting my prior BLOG may have caused.
johnkwan
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Saturday, September 13, 2008
Apparently I have created some stir among the LANAP community and higher ups as noted in the following email.
Subject: LANAP
Date: Sat, 13 Sep 2008 07:52:39 -0700
From: rgregg@millenniumdental.com
To: periEau@hotmail.com
Dear Dr Kwan,
I read your post on DentalCompare.com about LANAP.
http://www.dentalcompare.com/Blogs/ViewEntry.aspx?entryid=3587
I am concerned about the LANAP dentist that you referred to. I would like information so that I might assist this LANAPer if he was not following the strict LANAP protocol that includes thorough mechanical instrumentation and root preparation. Of course, that’s the point of my email and post—appropriate investigation into the facts of the matter before passing judgment. You were not informed of the facts of LANAP when you made a public post and misrepresented it. I am skeptical that you made an appropriate inquiry into the dentist and the circumstances by which the patient was treated. It’s hard to pass judgment when you don’t have all the information if your intent is to be fair. In fact, the ADA has ethical guidelines on professional fairness and justifiable criticism that have been adopted and posted on the AAP website, to wit:
ADA Principles of Ethics and Code of Professional Conduct
SECTION 4 — Principle: Justice ("fairness")
The dentist has a duty to treat people fairly.
This principle expresses the concept that professionals have a duty to be fair in their dealings with patients, colleagues and society. Under this principle, the dentist's primary obligations include dealing with people justly and delivering dental care without prejudice. In its broadest sense, this principle expresses the concept that the dental profession should actively seek allies throughout society on specific activities that will help improve access to care for all.
Code of Professional Conduct
4.C. Justifiable Criticism. Dentists shall be obliged to report to the appropriate reviewing agency as determined by the local component or constituent society instances of gross or continual faulty treatment by other dentists. Patients should be informed of their present oral health status without disparaging comment about prior services. Dentists issuing a public statement with respect to the profession shall have a reasonable basis to believe that the comments made are true.
Advisory Opinion
4.C.1. Meaning of "Justifiable." Patients are dependent on the expertise of dentists to know their oral health status. Therefore, when informing a patient of the status of his or her oral health, the dentist should exercise care that the comments made are truthful, informed and justifiable. This may involve consultation with the previous treating dentist(s), in accordance with applicable law, to determine under what circumstances and conditions the treatment was performed. A difference of opinion as to preferred treatment should not be communicated to the patient in a manner which would unjustly imply mistreatment. There will necessarily be cases where it will be difficult to determine whether the comments made are justifiable. Therefore, this section is phrased to address the discretion of dentists and advises against unknowing or unjustifiable disparaging statements against another dentist. However, it should be noted that, where comments are made which are not supportable and therefore unjustified, such comments can be the basis for the institution of a disciplinary proceeding against the dentist making such statements.
Furthermore, while your advocacy of the Perioscopy is understandable, your promotion of it when it is no longer available is difficult to understand and your motives therefore questionable.
Further to my inquiry and investigation into the facts of this matter, I would appreciate it if you would forward to me the name of the LANAP treating dentist that didn’t measure up in your estimation. Should it prove necessary, further investigation into this matter through the ethics process with the Alameda County Dental Society will reveal the identity of this dentist LANAPer and the level and extent of your due diligence before posting your criticisms in a public forum. A public retraction and apology on Dental Compare would go a long way towards diffusing and mitigating the defamatory remarks towards LANAP and the professionally disparaged individuals that have been impugned and maligned by your comments.
Alameda County Dental Society
Component Contact: Norma Claassen, CAE
Address:
Ste 102
1345 Grand Ave
Piedmont, 94610-1000
Telephone Number: 510.547.7188
Fax Number: 510.547.7191
E-Mail Address: acds@sbcglobal.net
Web site: http://www.alamedacds.org
I look forward to you reply.
Respectfully,
Robert H. Gregg II, DDS
Private Practice
President & Chairman of the Board
Millennium Dental Technologies, Inc.
10945 South Street, Suite 104-A
Cerritos, CA 90703
O: 562-860-2908
F: 562-860-2429
C: 562-577-2454
www.millenniumdental.com
rgregg@millenniumdental.com
I immediately replied:
Dear Mr. Gregg,
My apologies for creating such a stir regarding my exposure to the LANAP procedure and I will print a retraction to my blog post that I hope will be fair and to your satisfaction.
I do not intend to follow up on your request to provide you with the dentist who's failure to clean the root resulted in a poor result with the technique. I'm sorry but I don't feel that I am obligated to you or Millenium Dental Technologies to provide that information. The fact that I microvisually "saw" the limitations in root debridement provided goes undenied and is a limitation to any technique that does not provide visualization.
As noted in a follow up reply, I am the President and CEO of Perioscopy Incorporated. This technology is still available to dentistry and my "motives" are purely clinical and beside the fact that I am so involved.
I do appreciate your concern and will certainly learn from this exposure.
All the best, John
John Y. Kwan, DDS
President, Perioscopy Incorporated
"Healing Through a Better Vision"
www.perioscopyinc.com
Diplomate of the American Board of Periodontology
practicing the art and science of periodontal and implant care
6333 Telegraph Avenue, Oakland CA 94609
(510) 547-1300, fax (510) 547-4976, www.peri-eau.com
See follow up BLOG for my formal response.
johnkwan
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Friday, September 05, 2008
When we perform periodontal therapies we would prefer to regenerate the attachment. That would be to see healing with cementum mediated connective tissue attachment. So if patients get better and are stable do we assume that this is the case? If patients fail or sites fail and pocketing reoccurs do we assume that the problem was healing with LJE? Maybe, but we really have little proof. LJE in my opinion holds up over time. We have histological proof in monkeys and in dogs. Non surgical and surgical healing typically results in a LJE. In some regenerative treatments we can achieve true new attachment. Maybe we can facilitate this with some of the Gem21s cases that we are now doing in conjunction with the Perioscpe.
The fact that we have been doing endoscopic debridements for 7 years now and don't see any more breakdown than we have with surgical patients treated in this practice over the years is some indication that an LJE holds up. But this is only clinical reality.
My contention with all the adjuncts out there is that there is no substitute for cleaning the diseased root. This is done most predictably by visualization. By seeing the deposits we also have a better opportunity to clean just what needs to be cleaned without over instrumenting.
Everyone who is using the Perioscope is getting great results. That is because the roots are clean and the body likes that.
johnkwan
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Thursday, August 28, 2008
Dr. Parker Workman and I have recently started a data analysis of 270 patients who were consecutively treated with endoscopic debridement and adjunctive antibiotics. These patients were treated from 2002-2004 and were followed for an average of 711 days; almost 2 years! In following blogs I will illuminate our results but that said, we now have some concrete proof of why we have virtually eliminated surgery for the treatment of periodontal disease.
Obviously, one can question a retrospective case series because there are no controls. Additionally one can question the results of a study done by the President and CEO of the company that owns the technology, albeit the treatment was done long before I owned it. I like the fact that the information is in the computer. A real smart guy like Parker got the data out and the numbers speak for themselves. We have so much more data and now I want to see what the results are for our hygiene staff!
johnkwan
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Monday, August 25, 2008
I was excited to present to this group but had no idea how dynamic a meeting they put on! Sharon Zastrow and Company puts on a killer meeting! Waiting in the buffet line I was chatting with an attendee and she asked if I thought dentists might be interested in participating. I thought I would have some time to chill but I was too compelled to attend the other presentations! Kristy Menage Briney, RDH, BS informed us about bio-adaptive therapy and the Damon Orthodontic System, Trisha Osuna, RDH, BS gave us a great update on dental products, filled with plenty of "pearls", and Betsy Reynolds, RDH, MS hit us with some shocking reality on the "Counter Culture" and the effects on oral health. All three speakers are captivating and truly know how to educate and entertain (we call it edutainment)!
I want to thank all of you who were so gracious to me and who were so appreciative of my message. I sincerely recommend your annual meeting to other hygienists and dentists around the country! You have got something great going and I look forward to seeing it grow so that others can take advantage of the wonderful venue, the great educational opportunity and the time spent with professional colleagues who are caring and seek that same growth!
johnkwan
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Monday, August 18, 2008
I saw a patient who went to Vancouver for some perio treatment. She had the LANAP done and the result was marginal. Among other sites, that were not treated (why?) I did an endoscopic debridement with micro ultrasonic instrumentation. When I got to the site in question I found gross calculus that was totally missed around the tooth outside the lesion. In the site that was treated there was still residual cal. It was apparent that there had been some debridement. It just was not complete.
The LANAP may be a reasonable option, but you still need to clean the root. That is one thing that is missing from this procedure because the laser does not clean. It "may" disinfect via laser energy or curettage but it DOES NOT CLEAN THE ROOT.
AND if you effectively clean the root, patients get better. This we know. This is what we do with the Perioscope every day. Without a laser.
johnkwan
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Friday, August 15, 2008
Well I guess if you shell out 60K for the Periolase you need to get your ROI...
As good as the LANAP may be you STILL HAVE TO CLEAN THE ROOTS.
Interestingly a patient who had the endoscopic debridement with adjunctive antibiotics brought in the ad. She had 6-11mm pocketing in multiple sites (16 sites). Today all but one site is resolved and stable (we are going to rescope debride that one).
Interesting that we can consistently get incredible results without a laser, without any surgical access, without any tissue engineering (although we are trying some Gem21s for certain situations), without any advertising...
All we are doing is cleaning teeth microvisually and it is actually like a video game!
AND this is a hygiene tool. So you hygienists out there get ready to see what you have been doing blindly. If you think you have great tactile sense, like me you have to think again and check your EGO, at the door.
johnkwan
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Friday, August 15, 2008
I saw Terrie today to recheck a spot that we had seen get worse. Isn't it hard to manage the ML furcations of upper molars? Anyway she is going to have it scope debrided and we are going to adjunctively place Arestin.
BUT, she was commenting about the water irrigator:
"best tool in the whole wide world!"
"even after flossing there's stuff that comes blowing out of my mouth"
"anyone who doesn't use it after gum treatment is a fool!"
"That's my opinion, and I'm stickin' to it!"
Go girl!!!
The Solution to Pollution, IS DILUTION...
johnkwan
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Wednesday, August 13, 2008
Just over 6 weeks ago one of our patients had an endoscopic debridement done by our hygienist Kris Wood, RDH .
( to view an example of what that looks like see: http://www.youtube.com/watch?=5sfQlX1G9KM )
The mesial of #15 had an 8mm pocket and when she got in there a root fracture was noted. This tooth did not have endo. Now yesterday at the reevaluation it is probing 5mm, with no bop and our patient is using a toothpick and adjunctive water irrigation (the Shower Breeze).
I originally figured that endo, root amp, or ext and implant were the options. Now, I am recommending just waiting. The tooth has a very nice gold crown, still has a root fracture but remains vital. We need to follow the periodontal attachment, the tooth vitality, clinically and radiographically and take care in function.
Sometimes "do nothing" can be a reasonable option...
johnkwan
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Friday, August 01, 2008
Well yeah!! Dr. Morris Waselynik, a periodontist in Mansfield, Ohio has been using adjunctive Gem21S or recombinent human Platelet Derived Growth Factor for over a year now. He has some amazing cases and today I tried my first one. If this works we might be able to amp up healing and regeneration with endoscopic closed debridement! Stay tuned...
johnkwan
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Thursday, July 31, 2008
The Dental Board of California requires an on-site inspection and evaluation of Consious Sedation providers every 6 years. As an DBC evaluator I try to do at least 2 examinations a year in our local area. This allows me to help our profession provide the safe delivery of IV conscious sedation, helps me keep up to date and I always learn from my experiences.
Today I was part of a team evaluating Kourosh Harandi, DDS, MSD, a periodontist in nearby Pinole, CA. He and his team passed with flying colors and it is great to know that he is providing a great service to his patients that benefit from being intravenously sedated.
This morning I was doing a sedation case and my patient was so happy that we could remove her fractured cuspid and graft the site in preparation for an implant with her anxiety eliminated.
It was my pleasure to commiserate with Dr. Gil Oliver the doctor who in the past 3 years sold his practice to Dr. Harandi and now nearing the age of 80, still practices 2 days per week, looks at least 10 years younger than his age, and is thrilled to be doing what he loves. He freely admits that he is truly blessed. BTW at one time Dr. Oliver employed Dr. Paul Rhodes, the periodontist that I bought my practice from...
My co-evaluator was Dr. Jay Salzman. He too is working 2 days per week, after having sold his practice to Dr. Brand Ahn, a student I had when I was a regular attending Clinical Prof at UCSF. Jay has such a calming smile and is another one who loves what he does. It was great to touch base with Jay about his tenure as a periodontist and Professor in the Bay Area. He is another one of the periodontal microsurgeons that the Bay Area can boast about.
Sorry this blog is longer than usual. It is just so great to have a day when I can connect the dots in such a way that my hand touches my heart and my smile goes ear to ear.
johnkwan
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Wednesday, July 30, 2008
Three hygienists are incorporated and have placed Perioscopes in dental offices in Manhattan, the Bronx and Queens. Their leader is Chrisoula Doulas, RDH known to me as "Soula". Since I use to live in Greece, Soula and I have this "village" connection. I had lunch with Soula this past weekend in Manhattan and we talked about her vision. She sees the practice of dental hygiene very differently than most hygienists. After having read an article about Perioscopy she was interested but "busy" with life. But after a patient mentioned Perioscopy to her she implemented a plan to incorporate, purchase equipment, collect partners, build a website, move this technology into 3 practices, pay for training, negotiate reimbursement with her dentists and start using the Perioscope! Did I say that she sees the practice of dental hygiene differently?!?
Oh, and did I mention that we also had lunch with Niko, her nine and a half year old who politely told his mother he would order for himself, while her 4 year old was home with dad? This woman has the New York Minute wired!
www.gumcareNYC.com
johnkwan
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Wednesday, July 30, 2008
I just read Michelle Hurlbutt's article on Chariside Diagnostics for Oral Cancer and it is definitely a must read! We are always on the look out and now the outlook is enhanced by tools like the VELscope, VizilLte and Oral CDx. Is a simple saliva test next?
I have been using the VELscope since last October because my colleague Ray Bertolotti, the adhesive dentistry guru said I needed to start using one. He loaned me his while he was away lecturing and I have not looked back. The first week I used it I had several patients with various lesions that were found to be VELscope negative and were clinically in the begnign and watch catagory, such as fibromas, lichen planus and hyperkeratosis. SOLD! I bought 2.
Read Michelle's article and then share the info with your staff!
johnkwan
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Monday, July 21, 2008
When placing implants the drills are typically straight up and down. Therefore your osteotomy is the same shape. If the coronal edge of the implant is below the crest of the bone then you have to flare the bone to accomodate the change in diameter between the implant and the abutment. The abutment can be a healing abutment or a prosthetic abutment. The need to flare the bone can be at the time of placement or at the time of uncovering.
Immediate implants are typically placed below the crest on the mesial and distal to get the coronal edge of the implant below the facial gingival margin and at or apical to the bone margin. If you are placing a provisional immediately the bone must flare to accomodate the flare of the abutment.
If you do not have bone profilers this task is tedious and less than precise. To see an example of how the bone profiler works see YouTube:
http://www.youtube.com/watch?v=l6kz-QdRf7A
johnkwan
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Monday, July 21, 2008
This past Friday I flew down to lovely Santa Barbara for a meeting with some dental heads and Microfabrica. I'll drop some names now: Pat Roetzer DDS, inventor and patent holder of Ultradent and Danville Materials products, Dennis Shanelec DDS the father of periodontal microsurgery and my mentor, John Yagiela DDS UCLA' s guru on local anesthetics and conscious sedation, Rich Tuttle DDS head of research for Ultradent, Ken Tittle DDS endo smart guy. Why me? With the Perioscope we are into the micro visual world and I had the day off...
We met at David Neubauer's beachside home perched on a cliff overlooking the beautiful Santa Barbara coast. Beats the heck out of the office or a hotel. David is a venture capitalist, works with dentists on transitional planning and is connected to Microfabrica.
Microfabrica, makes the most unbelievably tiny instruments using a proprietary method called EFAB; electomechanical fabrication. It is a way of layering different metals into a block that when the "sacrificial" metal is etched out what is left can be as complicated as a tissue remover that will fit into a blood vessel with moving parts that can spread the lumen and cut/clear debris off the walls.
What does Microfabrica have to do with dentistry? WAIT AND SEE!!
www.microfabrica.com
johnkwan
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Wednesday, July 16, 2008
I saw a patient a couple of months ago that had a 20+ year old implant with bone loss and pocketing. Reviewing the xr I could see residual cement that had been there for 20+ years. SO I said: "let's use the Perioscope to remove the cement".
I got in with the scope and found cement right away. Removed it. Took an xray and it was still there only different looking. I tried to blindly remove more pieces but ended up just moving them around; as I could see on the xrs.
Today we did open debridement surgery and found 5-6 small to medium pieces of cement. The moat defect was bone grafted and the flaps replaced.
I love the Perioscope but you can't force a square peg into a round hole...
johnkwan
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Tuesday, July 15, 2008
BUT if you don't then you can't see the subCal and then you can't clean it. I took out #31 on a patient today that was compromised to begin with but it did not get better and just got worse. I wanted to rescope it but my patient elected to have it removed. When I had it out I could see the coronal half of the 10mm pocketing very clean but I totally missed the apical half and so ends the life of that poor second molar.
That's why they call it a "practice". As good, as experienced, as on top of my game, I think I am, I was "schooled" today. And my patient is a laporoscopic surgeon...
johnkwan
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Monday, July 14, 2008
There is a product that you can find on the internet called Periogen. It is a powder of various phosphates that claims to dissolve subgingival calculus incrementally over time when used in a water pik with a pik pocket attachment. Anecdotally, patients claim to get better.
Doug Anderson the inventor has a protocol pending that will use the Perioscope to help prove that this works. He has asked me to help him since I am the Pres/CEO of Perioscopy Incorporated. He is now looking to do his study at UCSF.
I have tried Periogen on 2 patients. One had lots of calculus, even on the xrs. I had her on the regimen for 2 months and saw no clinical or radiographic change in the amount of calculus. Her soft tissues got better, but that could have been from the initial dosing of metro/amox and also the adjunctive water irrigation. There was plenty of calculus to remove endoscopically at the time of treatment.
I had another patient who had recurrent pocketing after falling out of maintenance for about 2 years. He was already using a water pik so we scoped some pockets to document subcal and then he used the Periogen for 2 months. Then at the scope debridement appointment we recorded the pocekted areas again before cleaning. This was not a very good case because he had minimal calculus in the first place. ONE site did show the calculus dissolved but this was a 5mm pocket on #15M. There was minimal cal in this site.
I do confirm that this calculus dissolved but I am not convinced that this is what happens across the board and to what extent remains to be "SEEN".
It certainly can't hurt, but adjunctive water irrigation certainly does not hurt either. I don't think that this therapy precludes any in office treatment. Although people searching the web may try anything to stay out of the office.
You can check out Periogen at Globaltonic.com
johnkwan
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Wednesday, July 02, 2008
Having provided periodontal endoscopic debridements for almost 7 years now, our practice has virtually eliminated periodontal surgery for the treatment of periodontal disease. This treatment along with adjunctive local or systemic antibiotics has proven to be better than surgery or any of the other non-surgical modalities that patients come in and have already had done.
Case in point: John, a long time patient, came in for an exam in late 2006 after having been absent for 5 years. He was seriously re-infected and had 7-10mm pocketing on 5 teeth, 4-6mm pocketing on another 11 of his total 22 teeth. I immediately put him on a course of metronidazole and amoxicillin and 2 months later performed a full mouth micro ultrasonic endoscopic debridement.
He has been on SPT every 4 months for the past 16 months and today I saw him for a reeval/SPT. He has responded wonderfully and now has one 4mm probing, no bop and though he has his share of recession where there was advanced pocketing, he is healthy, happy and another example of what we seem to be able to accomplish in the most MINIMALLY INVASIVE way.
johnkwan
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Tuesday, July 01, 2008
In times of recession, dentistry seems to see slow downs along with other businesses like restaurants, the travel industry and the housing market. Well we periodontists like to treat recession with a myriad of mucogingival procedures. Albeit most patients will wait out a recession or at least until the end of the year when their benefits are about to go away!
Treatment #1: Use your government rebate to finance your co-pay on this AlloDerm root coverage graft.
http://www.youtube.com/watch?v=TtsLMwQhYLE
Treatment #2: Don't sell off your tanking stocks, use the dividends from those blue chippers to help treat the recession with a lateral sliding graft.
http://www.youtube.com/watch?v=dLJtzmrUx3c
Treatment #3: Recessions are supposed to last about 6 months so we should see the bottom soon and then you can use your consumer confidence dollars to treat the recession on the lingual of that lower anterior tooth that you messed up with your "cool" tongue piercing.
http://www.youtube.com/watch?v=Odln1DOX5ZA
For periodontists recessionary times will always keep us busy. We take the low gum line and make it high again. We take that ugly recession and make it like it never happened. All it takes is a little working of the investment strategy, a capital contribution and a sound treatment plan backed by your perio advisors who have taken many a patient through the throes of RECESSION ;)
johnkwan
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Monday, June 30, 2008
Today I had a full mouth endoscopic micro ultrasonic debridement that included extraction of #1,16 and 24 and splinting of #22-27. The root was removed off #24 and it was bonded back into the splinting. All the incisors were mobile. So after the scope debridement (27 teeth) I etched the contact areas and after bond agent, used flowable composite to bond the contacts. Next I bonded #24 crown back into place. With all the teeth initially stabilized, I re-etched, reapplied bond agent, and bonded the everSTICK Perio in place. This flexible glass fiber is impregnated with Bis-GMA and although somewhat technique sensitive, this fiber works GREAT! And it does not fray like Ribbond when exposed. After bonding the fiber in place I covered it with a thin layer of flowable composite. The occlusion was checked and adjusted.
I have found this method to be very predictable and stable for splinting periodontally mobile teeth.
check out this product at Preat: http://www.preatstore.com/mm5/merchant.mvc?
johnkwan
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Wednesday, June 25, 2008
This 2W cordless laser has a wireless pedal and several automatic settings. There are disposable tips instead of cleaving a long fiber. I was able to use the prototype today. The company is taking orders but is not delivering product until the unit goes through more testing. I was doing a Perioscopic debridement and there was a furcation that I want to open to help the patient access this for easier OH. There is a curettage setting at .4W continuous wave so I thought I'd "see" how it worked endoscopically. This is not enough power to actually remove sulcular epithelium. Maybe it will work for "disinfection", which is a claim that laser perio is making. The tips are rather fragile compared to my old ADT diode laser and I broke the only 2 that we had. The broken tip did still perform. The signal between the pedal and handpiece cut out several times and the company is working on an antenna modification to accomodate the need for a reliable signal. After using it at 2W continuous wave I was able to start my GV procedure but the battery ran out and the others that the unit comes with were not charged so I ended up using my own laser. I noted the handpiece gets fairly hot to the touch.
I have tried using my laser before to remove sulcular tissue tags to make endoscopic visualization easier but it just does not work fast enough. I tried the same with the Stylus at 1.4W CW and although we noted some of the tissue could be vaporized it was only minimal and slow. It may be because there is so much fluid in a "scoped" pocket. Maybe we can develope a shielded rotary cutter similar to the ones used in arthroscopy, but much smaller....
johnkwan
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Wednesday, June 25, 2008
Today I was performing a subgingival restoration for a patient of mine. He ended up having caries under the crown margin of #4D. This is his terminal abutment of a roundhouse fixed bridge that is removable over copings on #4-11. After removing the bridge I was able to easily visualize the distal of #4. Using a diode laser at 2W pulsed I removed enough of the tissue margin to see the healthy part of the root. Using the high speed and a round bur I opened the metal coping enough to access the caries underneath. Then with the straight and curved diamond ultrasonics I was able to clean out the caries much easier than if I were to be using the high speed. Much more control. I had not used these for tooth preparation before and now these will be part of my options in the future. After caries removal I etched, placed bond agent and Gerestore. All done using the microscope. I should have recorded it but I ran out of tapes!
johnkwan
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Friday, June 20, 2008
I have made several sets of prototype diamond coated ultrasonics to use as cutting instruments during endoscopic debridements. Recently I made a video using the diamond ultrasonic for the cutting off of a subgingival enamel projection. The instrument is powered by a 25k manually tuned magnetostrictive machine made by the Tony Riso Company. The instrument is a Riso P-100 insert that we coated with 300 grit diamonds.
Check out the video on YouTube: http://www.youtube.com/watch?v=d7OkAnXaoh4
johnkwan
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Thursday, June 19, 2008
Choose Your Attitude, Every Day
Play
Be Present
Make Someone's Day
My first patient already made my day!
He came in and had endoscopic debridement with adjunctive zithromax just over a year ago.
We have seen him every 3 months and today I did his reevaluation and supportive periodontal treatment.
He had 5-6mm pocketing around 12 of his 26 teeth and 7mm pocketing on 3 of them.
Today he is healthy with some 4mm probings and into the class III furcation on #30 it probes 6mm from B and L.
He made my day in 3 ways.
He got better without any surgery.
He complemented my staff on how we took care of him and showed him how to care for his periodontal condition.
BUT most of all, when I asked him about what he was doing this summer, he said he was going back to his home town of Alliance, Nebraska for a couple of weeks.
He has purchased his old elementary school and turned it into a place where artists now have their shops and studios. Growing up in Nebraska was all about "jocks and sports" so he is making up for his old attitudes about artists. He also has another building he has remodeled that the Chamber of Commerce and 2 non-profits are soon to occupy. His next project is to help build a performing arts center to be shared by the town and two local colleges.
Dennis, YOU ROCK! Way to GIVE BACK!
johnkwan
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Tuesday, June 17, 2008
Well, I lie....;)
I spoke to Dr Jerry Zackin, past president of the AAP and dental benefit code GURU about just that. The "CODE" issuse has been brought up before at their meetings every other year and here is the skinny: Dental Codes are for PROCEDURES. How you do them is up to you. So Scaling and Root Planing (best described as Periodontal Debridement)) in a full or partial quadrant, 4341 and 4342 can be done with "the back of a butter knife". Again, HOW you do them is up to you.
Even though I don't like the idea of dental benefit plans dictating treatment (decisions), if the "Plan" thought it was a good idea then the "Code" would probably happen.
Code or no code there are multiple models that reflect a successfull incorporation of Perioscopy. I'm working on a report of what that looks like by surveying our top 20 customers.
John K
johnkwan
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Tuesday, June 17, 2008
Since my first week on the dentalcompare blog the bloggage has been blocked. Since it is working now I can let you know about a patient I saw today. Her mouth is now so much healthier. She had #6 and 10 with bone loss all around, class III mobile and pocketing 8-10mm, among several other sites with 6-8mm pocketing.
After a "shock treatment" of metro/amox, we set her up to remove and graft #6 and 10 sites along with Perioscopic debridement of the other pockets. A stayplate with ovate pontics was delivered at the first treatment visit.
After 5 months healing of the bone grafts, implants were placed with some additional bone grafting and AlloDerm augmentation to create more natural root prominence profiles. Both implants were placed in a one stage fashion. The implants were ready to restore after 2 months.
I have a video with similar surgical elements on YouTube:
http://www.youtube.com/watch?v=j5-eqoBr46U
For more information on Perioscopy see: www.perioscopyInc.com
johnkwan
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Thursday, May 29, 2008
Are you kidding? My last patient today came and she is a beautiful 30ish woman who is seemingly ignoring her oral care. She had an abcess on the lingual of #29; pain, swelling, 8mm pocketing. Looking around I noticed the tongue piercing and what do you know? 5mm or recession on the lingual of #24...
I mentioned that and she said: "so I should change it to plastic?". I looked at her and then she said: "oh, I should take it out...". I guess I gave her the "look".
Anyway I did some gentle micro ultrasonic debridement in the LR sextant and prescribed her a Zpack. I suggested some warm salt water rinses, milk the abcess as tolerated, floss more than weekly and I'll check her out in 7-10 days. We also made her an appointment for a full exam. I gave her my card for Perioscopy Incorporated because endoscopic debridement will be what I suggest for treatment vs surgery or blind debridement and there is also a great video of a CT graft for a patient who had recession on #24L from a tongue piercing...
Root Coverage Grafting, Recession from Tongue Piercing
ttp://www.youtube.com/watch?v=Odln1DOX5ZA
I sincerely hope she takes that $%&*# thing out! But that reminds me of when I was stationed in Germany and I did a really nice graft on an Airman who got recession from dipping. One night we were out at a local gasthaus and I saw him playing foosball with a wad in his mouth... His explanation was: "well, sir, I know you can fix it". Sheesh!!!
johnkwan
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Wednesday, May 28, 2008
Today was fun! I saw a patient 4 months ago with a fractured #22 and we removed it, cleaned out the socket and grafted it with my bone cocktail putty, which is a mixture of Dynagraft D (a demineralized bone powder in a gel), mineralized freeze dried bone powder and some tetracycline powder. Powder, powder and more powder... She transitioned with a stayplate which had an tooth colored ovate pontic. Today we placed an Zimmer 3.5 x 10, HA coated Tapered ScrewVent implant, one stage and flapless. I was prepping for a 13 but the lingual cortex was depressed and I perfed the bone but not the soft tissue. Prior to placeing my implant I made up some more of my bonylicious cocktail and placed it over the perf inside the implant osteotomy. With my microscope looking right down into the osteotomy I was able to see exactly where to put the graft. In with the implant, on with the healing abutment, adjust the stayplate and we'll see her next week.
This afternoon I saw a nice 30ish woman with severe resorption of #9. The Physics Forceps cracked the crown off and between periotome and sectioning I removed the 15mm root with minimal effect on the bone of the socket (at 10-20x). We then prepped the site for a 4.5 x 13 Zimmer Tapered ScrewVent implant, grafted the coronal space defect, set on a provisional abutment, modified a pre-selected polycarbonate crown and after adjusting it out of occlusion and disclusion, she left with a new tooth! That takes about 2 hours or less.
These cases will probably show up on YouTube later on this year. If you want to see something similar check out:
Immediate Implant/Provisional; Physics Forceps
http://www.youtube.com/watch?v=Dq6Bo2Co2R4
or
Immediate Implants & Provisionals
http://www.youtube.com/watch?v=wbHn5HjhT9c
JohnK, DentalCompare, Perio Editor
johnkwan
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Tuesday, May 27, 2008
Ok they asked me for a catchy title and I don't know what came over me to think of this one. Maybe it was on an evening when I was listening to Beyonce and thinking about being a gum and bone specialist. I DON'T THINK SO!
ANYWAY, I am honored to be with DentalCompare and I hope that I can provide some insight to my periodontal practice.
Today has been very interesting. Among exams and checks I did a Perioscopic rule out for a fracture. My patient presented with #7, endo treated, loose crown, loose tooth, and 7mm pocketing on the distal. After local with articaine, I adjusted the tooth out of fremitus then scoped while doing micro ultrasonic debridement. No fracture, but a very dark root on the distal. The crown won't come off because of the undercut between the loose post and the loose crown. I have a feeling that there has been leakage and the tooth is toast. We will probably end up transitioning to an implant. See YouTube and search "periodontal microsurgery" for some examples.
One of my pole vault kids (I am a high school track coach) got some AlloDerm root coverage grafting today. He had recession and no keratinized tissue on the facial of #27, 28 area. That went very well and in the coming months I will make a YouTube video of that. I will show that tonight at "Video/Pizza Night" at UCSF with the perio grads.
THEN, I have a patient who had implants placed (at another office...) in the #8,9 sites and they ended up too far facial and are peaking out way above the desired gingival margins. IF that weren't enough she lost #7 to failing endo and #10 crown just fractured off at the gingival margin and the #9 implant presents with swelling and infection! OH #%$&*!! So we are taking out 8,9 and 10 and grafting the sockets with BG putty (also on YouTube). When all heals we will do tomos and figure out her options.
Ending on a good note I saw an implant patient that we did a flapless placement in the #30 site. Very routine with the exception of probably nicking the gingiva on the lingual of #31 where there is a bony exostosis and very thin tissue. Well then say hello to a small perf and fortunately she had minimal pain. This took 6 weeks to heal but today at her post op visit; all healed over. Next step: implant restoration.
So ends an interesting day and that doesn't include anything about our new phone system!