1. A new concept of treating
periodontal disease
TIP treatment
Dr. Yulia Grebneva, Montreal, Canada

2. Tri-Immuno-Phasic Therapy
• Dr. William Hoisington, DDS, Seattle, USA

3. Phases of the therapy
• Defense phase (Immune reaction to cleaning
the bone after BOST)
• Regeneration (stem cells)
• Healing with the new attachment (perio-aid)

4. 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

5. 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

6. 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.

7. Stage one. Stem cells moving.
The stem cells can move along
it and up the root surfaces at the rate
of 0.5mm per day for eight days and
thicken the layer on the clot. To permit
this activity it is also important to keep
the epithelial attachment away from the
roots. This is done with the oral hygiene
technique that keeps the pocket open
and also inhibits the reformation of the
sticky layer .

8. 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

9. 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.

10. Stage four. Bone maturation. 9
months.

11. Case presentation #1. Dr. Grebneva

12. 7 days after the treatment Dr. Grebneva

13. 1 month after the treatment
Dr. Grebneva

14. 1 month after the treatment
Dr. Grebneva

15. Case presentation # 2 Dr. Grebneva

16. After the treatment. 3 weeks
Dr. Grebneva

19. BOST vs Flap surgery approach

20. 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

21. 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

22. 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

23. 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

24. Advanced Dental Diagnostic Test
Holland
• Bacterial DNA test. Polymerase chain reaction.

27. Advantages of the test
• Treatment planning
• Antibiotic choice
• Patient motivation
• Treatment control (ones a year)

28. Presenting TIP in Belgium.
Implantology Club. 2003

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

30. Dubai Wellbeing conference. TIP
presentation. 2005

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

32. 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