Perio Protect

Perio Protect is a system of custom fitted trays and medicated gel that are worn together to treat periodontal disease. I have read several articles lately that mention this treatment and seen advertisements in professional journals. I have not used this system with my patients and never heard anything about it in school, but I was curious. As the creator of this site I want to give you as much information as I can about treatments available and the research supporting them. The idea behind the Perio Protect system is that if the medication can be held right where it is needed it will be delivered safely and easily while not being flushed away by saliva. This is what I found on the product, how it is used and the clinical studies supporting its use.

What is Perio Protect?

Trays used with the perioprotect system

Perio Protect Trays

Perio Protect consists of two things. Custom trays which are used to hold medication in place, and the medication itself, which is called Perio Gel.

Custom trays called Perio Trays are made by your dentist. These trays require a very accurate impression of your teeth and gums so that the hydrogen peroxide gel placed in them is delivered properly into periodontal pockets. The accuracy of the trays is extremely important. If the proper type of impression is not taken, or it is taken by someone who is not properly trained it will not work. This means wearing any old tray with hydrogen peroxide in it will not be beneficial.

The method of delivery using Perio Protect is superior to many other locally applied antibiotics because it can be used in more areas. Most locally applied antibiotics can only be used in periodontal pockets that are at least 5mm deep. This depth is needed to keep the antibiotic in place. Shallow pockets will not hold the antibiotic and it will be brushed, rinsed or flushed out while chewing. This makes these delivery systems effective only in more advance stages of periodontal disease.7

How is Perio Protect Used?

Perioprotect

Perio Protect trays need to be worn as prescribed by your dentist. Some patients may need to wear them up to six times a day for 10-15 minutes each time. Patients with mild gingivitis may only need to wear the tray one or two times a day for ten minutes. Patients that are working to maintain their oral health after active treatment with Perio Protect must wear their trays 1-2 times a day for ten minutes per session.7

The medication that is placed in the Perio Trays is a low dose hydrogen peroxide gel (1.7%) called Perio Gel with other medications sometimes added. I have found articles mentioning the use of a vibromycin syrup being added to the Perio Trays with they hydrogen peroxide.1 Vibromycin is a type of antibiotic. The doses used in Perio Trays are very low, below what you would use if taking the medication in pill form.1 Unfortunately the company website doesn’t specify all possible medications that can be used in the trays. They say that the make up of the gel depends on the patients’ needs. In many cases only the hydrogen peroxide gel is used with good results. Hydrogen peroxide has been used in dentistry for over 70 years. In low doses it can be used safely without risk of cancer. Long term low doses of hydrogen peroxide can help reduce plaque and gingivitis.5 The difficulty with swishing with a low dose of hydrogen peroxide is that it does not reach into deep pockets.

Perio Protect has been studied in conjunction with the usual treatment for periodontal disease, scaling and root planing, and alone.

What the Science Says

oral bacteria

Bacteria in an Oral Biofilm

Clinical studies on Perio Protect show that use of Perio Protect in conjunction with scaling and root planing reduces pocket depth more than scaling and root planing alone.7 Disease severity was reduced in both mild and more severe cases of periodontal disease using Perio Protect in conjuntion with scaling and root planing.7

In one study they were looking at the ability of the Perio Trays to deliver medication into pockets as deep as 9mm, which the study concluded was possible.1

Reduction in the amount of bacteria was seen in studies of the Perio Protect system, showing that Perio Protect is a good addition to periodontal therapy when used in conjunction with scaling and root planing.8 Use of Perio Protect for just 17 days reduced the number of periodontal bacteria by 99.98%.4

Perio Protect is as effective at reducing bleeding on probing six months after treatment regardless of if method of use is full mouth scaling and root planing followed by Perio Protect or if Perio Protect is used before localized scaling and root planing.3

Perio Protect use with scaling and root planing resulted in similar probing depth as those who only had scaling and root planing, but a lower level of bleeding on probing that the scaling only group after 6 months.6

One case study showed increase in bone support after use of Perio Protect trays.2 It is important to note that a case study is only looking at one case, that means that it is not necessarily a good idea to apply the findings of a case study to the general population.

Use of Perio Protect trays for 14 days reduces the amount of C-reactive protein in the blood. C-reactive protein is found in the body when there is a low-grade inflammatory disease present. Many common diseases are inflammatory diseases, including periodontal disease. Diabetes, cardiovascular disease, low birth weight, respiratory disease and brain abscesses are also associated with C-reactive protein and are inflammatory diseases.10

Initial studies of Perio Protect show that it can be beneficial for all levels of periodontal disease and gingivitis, as all levels showed some improvement during this early study.11

Bacteria in the mouth live in complex biofilms. Regularly using an oxidizing product helps break up biofilm consistently.9 (Hydrogen Peroxide is an oxidizing agent) When using Perio Protect before scaling and root planing the reduction in biofilm is beneficial to treatment of periodontal disease8.

Exclusions from clinical studies: Diabetes, Heavy calculus, braces, genetic predisposition to periodontal disease, pregnant and lactating women.7

Reported Side Effects

During clinical studies some participants reported the following side effects:

  • sensitivity7
  • occasional discomfort when placing trays due to TMJ problem7

My Opinion on Perio Protect

As I mentioned earlier, I do not have any personal experience with this product. The research shows positive results when used properly. My concern is that patients may not be compliant with such a strict regimen. If it is hard to remember to floss once a day, I am not confident that patients would be willing to use trays up to 7 times a day. Especially since this is not a short term treatment. Even if trays don’t need to be worn as frequently for maintenance it is still a big commitment for patients. Also, most of the research I was able to find was from studies by the Perio Protect company. I would love to see more independent research on the product. At this time I don’t think this would be something that I would incorporate into my periodontal procedures, but in the future, for some patients it may be beneficial. I would love to hear what other dentists and hygienists feel about this product. Do you use it at your offices? How do you and your patients like it? How compliant are patients who are put through Perio Protect therapy? Comment on this article if you have any experience or send me a message. I would love more input.

References

1Dunlap, TDC Keller, M Marshall, JW Costerton, C Schaudinn, BJ Sindelar, and JR Cotton. Subgingival Delivery of Oral Debriding Agents: A Proof of Concept. The Journal of Clinical Dentistry. 2011 November(XXII-Number 5):149-158.

2Keller DC. How to Manage Oral Biofilm. Dental Products Report. 2010 July(7):54-55.

3DC Keller DMD, LT Nguyen, BS, LR Jobe, BS, and BJ Sindelar PT, PhD Perio Protect LLC, Saint Louis, MO; School of Physical Therapy, Ohio University, Athens, OH Preliminary Data on Periodontal Disease Treatment Using Topical Oxidizing Agents. AADR Annual Meeting, Washington, DC. March 3-10, 2010, poster session.

4D.C. KELLER , B. COSTERTON , C. SCHAUDINN , and G.S. KELLER , Perio Protect, Saint Louis, MO, USA, USC School of Dentistry, Los Angeles, CA, USA, Keller Professional Group P.C, St. Louis, MO, USA. SEM Results of Periopathogenic Control with the Perio Protect Method. The IADR/AADR/CADR 85th General Session and Exhibition (March 21-24, 2007).

5Marshall MV, Cancro LP, Fischman SL. Hydrogen peroxide: a review of its use in dentistry.
Journal of Periodontology. 1995 Sep;66(9):786-96.

6C.M. Mitchell, D. Keller, L. Weaks, B. Sindelar. 6-Month Multi-clinic Treatment of Periodontal Disease Using Topical Oxidizing Agents. AADR Annual Meeting, Tampa, FL. March 21-24, 2012, poster session.

7Mark S. Putt, MSD, PhD, Howard M. Proskin, PhD. Custom Tray Application of Peroxide Gel as an Adjunct to Scaling and Root Planing in the Treatment of Periodontitis: A Randomized, Controlled Three-Month Clinical Trial. The Journal of Clinical Dentistry. 2012 March(XXIII-Number 2): 48-56.

8Schaudinn C, Gorur A, Sedghizadeh P, Costerton J, and Keller D. Manipulation of the microbial ecology of the periodontal pocket. World Dental 2010 Feb-March: 14-18.

9Schaudinn C, Gorur A, Keller D, Sedghizadeh PP, Costerton JW. Center for Biofilms, School of Dentistry, University of Southern California, Los Angeles, CA90089, USA. Periodontitis: An archetypical biofilm disease. J Am Dent Assoc. 2009 Aug;140(8):978-86.

10C. STEELE, Keller Professional Group PC, St. Louis, MO, USA, B.J. SINDELAR, Ohio University, Athens, USA, and D.C. KELLER, Perio Protect, Saint Louis, MO, USA C-reactive protein changes during Perio Protect treatment of periodontal disease. The IADR/AADR/CADR 85th General Session and Exhibition (March 21-24, 2007).

11 WENTZ 1, A.M. BLAKE 1, D.C. KELLER 2, and B.J. SINDELAR. Initial Study of the Perio Protect Treatment for Periodontal Disease, Ohio University, Athens, USA, 2Keller Professional Group PC, St. Louis, MO, USA. The ADEA/AADR/CADR Meeting & Exhibition (March 8-11, 2006).

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