Perioscope-Based Endoscopy in Modern Periodontal Care: A State-of-the-Art (SotA) Review

Periodontal therapy has traditionally relied on tactile sensation and indirect clinical indicators to guide subgingival instrumentation, a limitation that becomes increasingly evident in deep periodontal pockets and anatomically complex sites. Despite decades of refinement in nonsurgical periodontal therapy, residual subgingival calculus remains a major determinant of persistent inflammation and disease recurrence. Optical enhancement technologies have emerged to address this fundamental limitation, among which Perioscope-based periodontal endoscopy represents the most advanced clinically available modality enabling real-time visualization of the subgingival environment. This state-of-the-art (SotA) review critically synthesizes the current scientific and clinical evidence on Perioscope-assisted periodontal therapy, positioning it within the evolving paradigm of minimally invasive, precision-guided periodontics. Contemporary evidence demonstrates that Perioscope-assisted therapy significantly enhances detection and removal of subgingival calculus compared with conventional tactile methods. Optical magnification allows direct visualization of residual deposits, root surface morphology, and furcation anatomy, thereby redefining the procedural endpoint of nonsurgical debridement. Clinical studies consistently report superior reductions in bleeding on probing and gingival inflammation, while probing depth and clinical attachment outcomes appear comparable to conventional scaling and root planing in short-term evaluations. Beyond nonsurgical therapy, periodontal endoscopy has enabled the development of videoscope-assisted minimally invasive periodontal surgery, offering improved clinical outcomes with reduced morbidity, gingival recession, and patient discomfort. Emerging applications in peri-implant disease management further expand the scope of optical enhancement in periodontal care. In summary, Perioscope-based subgingival endoscopy represents the current pinnacle of optical enhancement in periodontal therapy. Its selective application in complex periodontal sites aligns with contemporary minimally invasive principles and signals a shift toward visually guided periodontal treatment. Continued technological refinement and long-term clinical trials will determine its future integration into standard periodontal practice.