The Perioscopy System, Part 1: Utilization and objectives

Meticulous instrumentation via the Perioscopy System is the cornerstone for successful treatment outcomes in nonsurgical periodontal therapy, regardless of adjunctives used. From their article The Perioscopy System, John Kwan, DDS, and Suzanne Newkirk, RDH, explain the best use and objectives of perioscopy while providing a list of treatment scenarios for candidates for endoscopy.

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By John Y. Kwan, DDS, and Suzanne Newkirk, RDH

The Perioscopy System is a 1-mm diameter fiberoptic camera that is attached to a dental probe (Perioscopy Explorer) and is then gently placed subgingivally. The images are immediately displayed on a chairside monitor and magnified 20-40 times, disclosing minute details that previously may have been undetectable, such as caries, root fractures, perforations, resorption and, of course, calculus.

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We have found Perioscopy eliminates the need for scraping the roots with hand instruments. Micro ultrasonic instrumentation is typically all that is used for this type of periodontal debridement.

“Micro Ultrasonics” refers to the use of powered instrumentation for supra and subgingival debridement with amplitude settings from low to high power. Manual tuning aids in modulating these cleaning vibrations to minimize water spray. The tip inserts are small, about the size of a periodontal probe.

We teach magnetostrictive ultrasonic instrumentation; however, piezo ultrasonics, hand instruments or combinations are utilized as well. A typical procedure can commonly use only one insert (a universal), which can adapt to almost all surfaces of the teeth. Occasionally, a set of curved inserts are used when additional angulation is needed for access. Advanced ultrasonic instruments are diamond coated for cutting.

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Perioscopy is best utilized while providing a two-handed technique which allows the operator to view and instrument simultaneously. The objective of perioscopy is to see what you are doing, not just to see what you have done.

Candidates for endoscopy include patients being treated for the following:

• initial periodontal therapy
• sites not responding to traditional non-surgical treatment
• residual pockets in maintenance patients who are resistant to surgical therapy and where surgery is contraindicated (medical reasons, or esthetics)
• during maintenance for chronically inflamed or increasing pockets
• suspected subgingival pathology such as caries, root fractures, perforations or resorption

As the above cases in other sections of the newsletter indicate, meticulous instrumentation via the Perioscopy System is the cornerstone for successful treatment outcomes in non-surgical periodontal therapy, regardless of adjunctives used.

More information on The Perioscopy System can be found on Dr. Kwan’s web site:
Dr. Kwan can be contacted at:
Suzanne Newkirk, RDH, can be reached at:

Kwan, JY, Enhanced Periodontal Debridement with the use of Micro Ultrasonic, Periodontal Endoscopy. March.2005.VOL.33.NO.3.CDA.JOURNAL. Available at

Kwan, JK, Workman, PD. Micro Ultrasonic Endoscopic Periodontal Debridement:
Retrospective Analysis of Treatment with at least 1 year Follow-up
Available at

Slim,LH. Perioscopy and ultrasonic efficiency. Volume 31 Issue 4 April 2011, RDH Magazine.
Available at

Slim,LH. Let it shine, or do it blind: Eavesdropping on a Perioscopy seminar. Volume 3I issue 5 May 2011, RDH Magazine. Available at

Pennwell web 171 200Dr. Kwan is a board-certified periodontist and maintains a private practice providing periodontal and implant care in Oakland/Berkeley, Calif. He is an Associate Clinical Professor at the University of California, San Francisco School of Dentistry. Dr. Kwan is also the President/CEO of Perioscopy Incorporated.

Pennwell web 170 213Ms. Newkirk graduated from the University of Alaska, Anchorage, in 1981 and has dedicated the last 30 years to excellence in clinical dental hygiene and periodontics. Suzanne is a periodontal therapist, dental hygiene coach and mentor. She is also a Perioscopy instructor and speaker. Ms. Newkirk is a member of the American Dental Hygienists' Association and Washington State Dental Hygienists' Association.

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