The use of the surgical microscope has opened up a whole new approach to treating periodontal disease. Many areas of bone loss  (periodontal disease) are due to microscopic problems on the root surfaces of the teeth. Among these are micro-accessory canals (small side canals branching off the main nerve canal of the tooth) and/or microscopic root defects. If magnification via a surgical microscope is not used in surgery, these problems are frequently missed. This has resulted in Dr. Abe developing new ways to diagnose and enhance the treatment of periodontal disease. The result is that the emphasis of treatment has changed from treating "pockets and bony defects" (the result of the disease) to treating the etiology, or the cause of the disease first  ie. these microscopic root defects. Once the cause is deteminded and treated, then the results of the disease (the pockets) are fixed. This is done by utilizing a minimally invasive approach, the surgical microscope, a piezosurgical drill and microsurgical instrumentation which results in decreased tissue trauma improved healing and higher success rates. Dr. Abe has found that these root defects, if not treated,  can result in failure or relapse if regeneration procedures (bone grafts) are attempted, even if the treatment is initially successful.

 

In the patient above, under magnification, a microscopic accessory canal was detected at the bottom of the defect (the dark triangle) between the first molar and second bicuspid. A  micro-restoration  (white dot about 1/3 of the way down the root of the molar) was placed to "seal" the microscopic accessory canal. It was placed to enhance the chance of success of the bone graft placed to regenerate the lost support around the tooth. A small diamond coated ultrasonic tip (piezosurgical drill) is used to prepare the micro-preparation (~ 0.5 - 1 mm in diameter). A special plastic filling material was then used to seal the canal. The bone graft was then be placed over the filling to restore support around the tooth. Note:The bone graft has covered the micro-restoration. If the etiologic factor (or cause) of the pocket and bony defect was not detected and corrected, and the bone graft placed, it would have been doomed to failure, because the root cause of the problem (the accessory canal) would not have been dealt with. Few periodontists utilize this technique since it requires a special micro-piezoelectric drill and magnification or are not aware of these problems. Dr. Abe has found the chances of success of these procedures are greatly enhanced with this technology.