Videoscope-Assisted Minimally Invasive Periodontal Surgery

CV-170Charles A. White Periodontics and Dental Implants have introduced the use of a VIDEOSCOPE to perform minimally invasive procedures to regenerate bone lost from periodontal disease. This procedure utilizes very small incisions, often only one stitch and patients consistently report minimal discomfort. Best of all, bone regeneration with the VIDEOSCOPE results in predictable bone regeneration without causing gum recession. Periodontal surgery no longer results in exposed sensitive roots!

What is V-MIS?

V-MIS is a minimally invasive surgical procedure to treat moderate to severe periodontal disease (deep pockets around the teeth).  The technique involves the use of a powerful videomicroscope (videoscope), that can display images up to 60x magnification in HD video, to enable Dr. White or Dr. Blansett to see what they are doing through a very small incision.  After the root surface and the pocket in the affected area(s) are surgically cleaned, a mix of bone grafting material and growth factors are placed into the surgical site and closed with a single stitch.  With this technology, they can avoid making large incisions or incisions around neighboring teeth that are healthy and regenerate lost support around diseased teeth.

What’s the history of V-MIS?

Periodontal surgery historically has not been a fun procedure for patients to have to go through.  Often, gum tissue will shrink, or recede, after periodontal surgery because large incisions had to be made on both sides of the teeth to get access to deep pockets in the gums and allow the periodontist to see what they were doing.  After the procedure, patients would often experience sensitivity to hot and/or cold substances, trap more food between their teeth, notice their teeth looked longer, and would even get cavities on the newly exposed root surface.  VMIS was developed in an effort to minimize and/or outright avoid these complications.  By making small incisions only over deep pockets, trauma to adjacent healthy tissue is avoided and after the procedure most patients experience very little to no pain.  Also, by preserving healthy gum tissue around the deep pocket, there is minimal to no shrinkage of the gums as they heal.  This avoids complications associated with conventional periodontal surgery.  V-MIS was first described by Dr. Stephen K. Harrel in 2013 and the first controlled clinical human study was completed also by Dr. Harrel in 2014.

Why is V-MIS important to periodontal patients?

Minimally Invasive Surgery = Minimal Post-op Pain and Complications!

Prior to the introduction of V-MIS, periodontists had to make large incisions on both sides of the tooth (cheek side of the teeth and the tongue side of the teeth) so they could see what they were doing and see the affected roots and bone to ensure they are clean.  With V-MIS, we rely on the powerful optics and magnification of the videoscope to let us see through incisions 10x smaller than we had to use before.  This minimally invasive approach translates into less trauma to the gum tissues during the surgery and much less post-op discomfort.  In fact, many patients report they took no medication for pain or they took only 1 or 2 doses and that was all they needed after the procedure.

Many patients would rather keep their tooth if possible than have it removed and a dental implant or other restoration placed to restore the missing space.  If the tooth is at risk from being lost from periodontal disease, V-MIS now enables us to regenerate lost bone around the diseased teeth like never before.  Patients with deep pockets around their teeth now have a more comfortable and predictable treatment option to help them KEEP their teeth.  By saving more teeth we are able to preserve facial support, chewing function, aesthetics, and phonetics.  Also, because V-MIS is so minimally invasive, patients that have other medical issues that may not be good candidates for procedures such as tooth extraction and dental implant placement can often have this procedure done with minimal discomfort and are able to avoid a more complicated and risky surgical procedure.  The combination of less trauma, superior visibility, and the use of bone grafts and growth factors allows us to predictably regenerate lost tissues around the teeth with the least amount of postoperative pain, sensitivity, or tissue changes.

Does research exist documenting the success of V-MIS?

Minimally invasive periodontal surgery was first described by Dr. Stephen K. Harrel and Dr. Terry Rees in 1995.  As time has passed and new materials were introduced, such as bone grafting materials and growth factors, more studies were published using these materials with the same minimally invasive surgical approach.   Minimally invasive periodontal surgical techniques using similar incision designs and  treatment methods were also published by Dr. Pierpaolo Cortellini and Dr. Maurizio S. Tonetti in Italy in 2007 and 2009.

The videocope was modified for use in periodontal surgery in 2012 and first described by Dr. Stephen K. Harrel in 2013 as videoscope-assisted minimally invasive periodontal surgery (V-MIS).  The first clinically controlled study was completed in 2014 by Dr. Harrel’s group in Dallas, Texas with results superior to any other technique currently available to treat deep pockets around teeth.  Since 1995, hundreds of patients and thousands of deep pockets have been treated using a minimally invasive surgical approach.  Dr. White has been doing V-MIS since 2014 with fantastic results that are in line with the results from Dr. Harrel’s research studies.

How can you find out if you are a candidate for V-MIS?

What is a pocket around your tooth?  What is a deep pocket?  Why is a deep pocket not healthy?

Everyone has pockets around their teeth, it is just a matter if they are healthy or diseased.  The pocket is simply the space between your gumline around teeth and where the gum fibers insert into the root of the tooth.  This fibrous attachment serves to seal the bloodstream off from the oral environment and prevents bacteria and other agents from getting into your bloodstream directly from your mouth.

Typically, healthy pockets are 1-3mm in depth, do not bleed upon probing (or tooth-brushing), and can be kept clean by regular brushing and flossing and regular dental cleanings twice a year.  Moderately diseased sites typically probe 4-5mm in depth and usually can be treated predictably with a non-surgical treatment approach called scaling and root planing (commonly called a deep cleaning).  Severely diseased sites probe 5mm or more and often are very inflamed and will bleed easily.  Deep pockets harbor bacteria and other irritants that cause chronic inflammation, and the seal around the teeth is broken, allowing substances into the bloodstream directly from the mouth.  These pockets are too deep to predictably treat with scaling and root planing only, and often require surgical treatment to fully treat the gum disease.

 V-MIS is best suited for patients who have severe periodontal disease, have already had scaling and root planing completed, and have good oral hygiene.  Severe periodontal disease often will present as pockets 5mm and deeper in localized areas of the mouth, often around the molar teeth.  V-MIS can predictably regenerate lost bone and tissue in these deep pockets and get them back to a healthy pocket depth (1-3mm).

If you have had a deep cleaning by your dentist or dental hygienist and still have deep pockets or pockets that bleed you could be a good candidate for V-MIS.  Your dentist will refer you to our office or you can contact us directly to schedule a comprehensive periodontal examination to determine exactly what treatment will be best.  As always, Dr. White will recommend treatment that is the most conservative, least invasive, and most predictable.  Many different factors go into deciding if a tooth can be treated with V-MIS, and Dr. White will take the time to answer all of your questions and evaluate you as a patient not just as a ‘tooth that has a problem.”