A new concept of treating periodontal disease TIP treatment

Dr. Yulia Grebneva, Montreal, Canada

Tri-Immuno-Phasic Therapy

• Dr. William Hoisington, DDS, Seattle, USA

Phases of the therapy

• Defense phase (Immune reaction to cleaning the bone after BOST)

• Regeneration (stem cells)• Healing with the new attachment (perio-aid)

The concept is based on

• Periodontal treatment (BOST, Bone One Session Treatment)

• Hygiene (perio-aid) that helps in generation of a new attachment and minimizes the risk of reinfection

• Proper nutrition, exercise, stress release, smoking cessation

BOST steps• “Stretched Flap" allows access all the

way down to the deep areas of the roots and the surface of the bone without incisions.

• Removing local obstacles that prevent healing and contaminating roots and or surfaces of the bone (plaque, calculus, granulations)

• Cleaning and reshaping bone craters and the necrotic surface of the bone

Healing after BOST• After the treatment, the pockets gradually fill in from the bottom with very

dense, partially mineralized connective tissue in about four to six weeks, and finally will become acellular. Once the new mineralized acellular connective tissue (MAC) attachment is in place in about a month, the bone naturally heals in under it. A new, dense layer of cortical bone forms over the healed inner (cancellous) bone in about 8-9 months.

Stage one. Stem cells moving.

The stem cells can move alongit and up the root surfaces at the rateof 0.5mm per day for eight days andthicken the layer on the clot. To permitthis activity it is also important to keepthe epithelial attachment away from theroots. This is done with the oral hygienetechnique that keeps the pocket openand also inhibits the reformation of thesticky layer .

Stage two. Maturation of the attachment.

• As healing time increases, the pockets gradually fill from the bottom with very dense, partially mineralized connective tissue in a time period of 4 to 6 weeks and finally it will become acellular

Stage three. MAC attachment completed. Maintenance.

• Once the new mineralized acellular connective tissue attachment is in place is in about one month, the bone naturally heals under it.

Stage four. Bone maturation. 9 months.

Case presentation #1. Dr. Grebneva

7 days after the treatment Dr. Grebneva

1 month after the treatment Dr. Grebneva

1 month after the treatment Dr. Grebneva

Case presentation # 2 Dr. Grebneva

After the treatment. 3 weeks Dr. Grebneva

BOST vs Flap surgery approach

Advantages of TIP (BOST)

• Non invasive. Healing is faster • Relatively comfortable for a patient• Less complications. No bone necrosis• Esthetically more acceptable• Less sensitivity• BOST is performed in a single session that sets up a

better condition for healing• Firm MAC attachment vs weak epithelium

attachment that prevents from reinfection

Who should get the treatment

• Patients that are concerned about esthetics• Patients that do not respond well to the initial

periodontal therapy• Everybody who has radiographically showing

bone resorption• Motivated patients

Patients motivation

• Periodontal bacteria's as a source of cardiovascular problems, conceiving problems, stroke etc…

• Progression of the untreated disease and loosing teeth

• Halitosis• Bacterial test

How DNA test is performed?

• Paperpoints from a kit is inserted in the sulcus in suspected areas for 10 seconds

• Paperpoints are sent to the laboratory• The test in ready in a few days by email

Advanced Dental Diagnostic TestHolland

• Bacterial DNA test. Polymerase chain reaction.

Advantages of the test

• Treatment planning• Antibiotic choice • Patient motivation• Treatment control (ones a year)

Presenting TIP in Belgium. Implantology Club. 2003

Meeting with ADD laboratory director P.Camp. Holland. 2005

Dubai Wellbeing conference. TIP presentation. 2005

TIP (BOST) article in Revue Trimestrielle. Implantologie. 2005

references• World Journal of Pharmaceutical Research TRI-IMMUNO PHASIC

PERIODONTAL THERAPY Dr. Y. Pradeep Kumar, Dr. V. Kalaivani*, Dr. K. Rajapandian and Dr. Maharshi Malakar , volume 5, Issue 9, 356-360. 2016

• Bangladesh Journal of Dental Research & Education Vol. 04, No. 02, July 2014 Recent Trends in Non-Surgical Periodontal Care for the General Dentist - A Review R Arpita, JL Swetha, MR Babu, R Sudhir

• William Hoisington New developments in perio: Tri-Immuno-Phasic therapy. Preventive Dentistry. Volume 1 issue 2.2006.

• Journal Implantologie, Revue Trimestrielle, 2005. Nice, France Le Traitement Parodontal Initial a l’aide du Bone One Session Treatment ( BOST) Feb 2005. ISSN 1763-1033. Dr.William HOISINGTON, Pierre DOGUOU, Dr. Yulia GREBNEVA, Dr. Didier HUGOT