MetLife-Thomas C. Kelley,DDS, MSD, LLC

As A Specialist, Dr. Kelley Offers The Following Services:

Complete Periodontal Examination- Performed by Dr.Kelley- This exam is the key step in determining a diagnosis and treatment plan.

Radiographs ( Xrays )- Radiographs should be current and of diagnostic quality. They are used for proper evaluation and interpretation of the status of the periodontium and dental implants. Abnormalities are noted.
The Panoramic Xray may be useful as an adjunct to intraoral films (periapical and bitewing Xrays), but have no value in periodontics , endodontics , and operative dentistry. Oral surgeons may get the greatest value of a panoramic Xray because it provides an overall view of unerupted teeth, cysts, and maxillary and mandibular fractures.

Prophylaxis

Scaling and Root Planing/ Local Chemotherapeutic Agents

Periodontal Surgery:
(See Illustrations of Periodontal Procedures )

1. Flap Surgery

Open Flap Debridement
Osseous Resection-Osteoplasty/Ostectomy
Crown Lengthening
Bone Grafting
Guided Tissue Regeneration (GTR)-with and without bone grafting

2. Gingivectomy/Gingivoplasty

3. Mucogingival Surgery

•Attached Gingiva Augmentation

Free Autogenous Gingival Grafts
Pedicle Gingival Grafts
Apically Positioned Flap Surgery

• Root Coverage

Pedicle Gingival Grafts
Semilunar Coronally Positioned Flaps
Free Autogenous Gingival Grafts
Subepithelial Connective Tissue Grafts- My practice performs a current technique for treating gum recession which does not require taking tissue from the patient's palate and avoids creating needless surgical trauma and discomfort to an uninvolved area. I utilize a material called Alloderm, an acellular dermal matrix tissue. Alloderm works the same as the patient’s own tissue, is as safe, and much more convenient. Advantages to using Alloderm include only one surgical site with faster recovery and more comfortable healing, larger or multiple areas can be treated in a single procedure, and more natural looking results. Note-The amount of root coverage is determined on a case by case basis.
"Although CT and ADM have a slightly different histological appearance, both can successfully be used to cover denuded roots with similar attachments and no adverse healing." Histologic Evaluation of Autogenous Connective Tissue and Acellular Dermal Matrix Grafts in Humans J Periodontol 2005;76:178-186.
To learn more about Alloderm, go to the link below :www.lifecell.com/patient/alloderm

• Frenum Operation

4. Combination of Various Periodontal Surgical Approaches

5. Implant Placement-To learn more about The Astra Implant System, go to the link below :www.astratech.com

6. Simple And Surgical Extractions

7. Biopsies- All biopsy specimens are submitted to the Oral Pathology Group at the Indiana University School of Dentistry

All reevaluations and post operative appointments are an essential part of treatment success and are included with the cost of treatment.

Supportive Periodontal Therapy ( SPT ) or Periodontal Maintenance- SPT or Periodontal Maintenance is started after completion of active periodontal therapy and continues at varying intervals for the life of the dentition. It is meant to maintain the periodontal health attained as a result of active therapy. It includes supragingival and subgingival removal of plaque and calculus, oral hygiene reinstruction, antimicrobial therapy as necessary, and surgical treatment for recurrent disease. Smoking cessation recommendations are meant to improve your periodontal and overall health.

Tooth Whitening- To learn more about Opalescence Tooth Whitening, go to the link below :www.ultradent.com

For more information on periodontal procedures, go to the American Academy of Periodontology link below: http://www.perio.org/consumer/procedures.htm

Electrosurgery is not performed at this office. In electrosurgerical procedures, the tissue is burned by a high frequency electrical current applied locally with a metal instrument or needle.

"The Laser"
Please educate yourself about this form of treatment.
Lasers are not used at this office. I am not involved in any clinical research or product study.
"Based on this review of the literature, there is a great need to develop an evidence-based approach to the use of lasers for the treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy." J Periodontol 2006;77:545-564.-This paper was written to help clinicians develop an evidence-based approach to the use of lasers in periodontal treatment.

The Effect of Laser Therapy as an Adjunct to Non-Surgical Periodontal Treatment in Subjects With Chronic Periodontitis:A Systematic Review- "No consistent evidence supports the efficacy of laser treatment as an adjunct to non-surgical periodontal treatment in adults with chronic periodontitis. More randomized controlled clinical trials are needed." J Periodontol 2008;79:2021-2028

Subgingival Microbiologic Effects of One-Time Irradiation by CO2 Laser: A Pilot Study- "A one-time use of the 3-CO2 laser in periodontal pockets did not sterilize or substantially reduce subgingival bacterial populations compared to negative controls." Journal of Periodontology 2007, Vol. 78, No. 12, Pages 2331-2337

Short-Term Clinical and Microbiologic Effects of Pocket Debridement With an Er:YAG Laser During Periodontal Maintenance-"The results of the trial failed to demonstrate any apparent advantage of using an Er:YAG laser for subgingival debridement." Journal of Periodontology 2006, Vol. 77, No. 1, Pages 111-118

Clinical/Scientific Papers Statement Regarding Use of Dental Lasers for Excisional New Attachment Procedure (ENAP)- "In conclusion, The Academy is not aware of any randomized blinded controlled longitudinal clinical trials, cohort or longitudinal studies, or case-controlled studies indicating that "laser ENAP" or "laser curettage" offers any advantageous clinical result not achieved by traditional periodontal therapy. Moreover, published studies suggest that use of lasers for ENAP procedures and/or gingival curettage could render root surfaces and adjacent alveolar bone incompatible with normal cell attachment and healing." This statement was developed by the Committee on Research, Science and Therapy and approved by the Board of Trustees of The American Academy of Periodontology.
The ENAP procedure may be used to remove granulated and infected or inflamed tissue around the involved teeth. It promotes healing of the periodontal tissues and a reduction in pocket depths around the teeth. It is contraindicated when osseous defects and/or a lack of keratinized mucosa is present. This procedure can only be used in very specific circumstances and therefore is limited in its scope.

"Can the use of lasers in periodontal therapy harm patients?"

"Yes and no. Each laser has different wavelengths and power levels that can be used safely during different periodontal procedures. However, damage to periodontal tissues can result if an inappropriate wavelength and/or power level is used during a periodontal procedure." AAP Website based on an AAP commissioned literature review on the topic.

"Can I trust the claims in an ad for periodontal therapy performed with a laser?"
"It is important to beware of advertising that sounds too good to be true because it very well may be. A dental professional can help you separate fact from hype."AAP Website

All laser devices distributed for both human and animal treatment in the U.S. are subject to Mandatory Performance Standards. The firm that certifies a laser product assumes responsibility for product reporting, record keeping, and notification of defects, noncompliances, and accidental radiation occurrences, as specified in sections 21 CFR 1000-1010. A certifier of a laser product is required to report the product via a Laser Product Report submitted to CDRH. Reporting guides and related regulatory information are available from the DSMA web site at: http://www.fda.gov/cdrh/devadvice.
An on-line search is available which allows you to search the CDRH's database information on medical devices which may have malfunctioned or caused a death or serious injury.-US FDA/ CDRH- Centers For Devices And Radiological Health- http://www.fda.gov/cdrh/consumer/index.html-See Problems With Medical Devices-type Dental Laser or Laser

Do you have questions about experimental medicine or clinical trials? Ask your doctor or write a letter to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218 Or call toll-free 1-888-644-6226

As a periodontist , I am cautious of the laser for periodontal treatment, especially if one attempts to replace tried and true methods. The ER:YAG laser costs between $25,000 and $40,000. Some companies lease their lasers for a certain dollar amount per use and will invariably mean higher cost for patients being treated with dental lasers. Lasers are marketed to dentists with claims that it can "boost the revenue","it's painless surgical trauma", and "eliminates the fear of surgery." Their suggestions are primarily based on manufacturers' claims of laser efficacy, and not on actual research data. Some researchers question whether dental lasers will generate excessive heat that can damage the dental pulp. I have seen patients who have had periodontal laser surgery and they have not responded well to it. These patients required another surgery utilizing conventional periodontal surgical techniques to achieve the desired result . Dental lasers will need several years of research and improvements to determine their effects. In my opinion, based on periodontal journal articles, lasers are not worth the risk.