Good evening, everybody, and welcome to tonight's webinar. My name is Bruce Stevenson, and I have the honour and privilege of chairing the webinar tonight. Before we get started, I'd like to say a big thank you to our sponsors, Perio Vive.
It is thanks to their generous sponsorship that we are able to bring you this free webinar this evening. And share some amazing technology, and, exciting products available to us, in the dentistry field. So, for those of you that are new to the channel, a little bit of housekeeping.
If you move your mouse over the screen, you will see a control bar pops up. It's normally a black bar at the bottom of the screen. There's a Q&A box there.
Click on that, type your questions in, and we will get to as many of those at the end of the webinar as what we can. And we'll get our, our, presenters and panellists to enter into a discussion and cover as many topics as what we possibly can. We are also recording the webinar, so, if you have something that you want to look at again, we are not able to go back on slides or anything else, but don't worry, the recording will be up on the webinar vet in the next 24 or 36 hours, and then you can go and have a look and rewind and stop and fast forward to your heart's content.
So that's, a great thing to have to go back to if you want to check some of the slides. Without further ado, I'd like to welcome our presenter tonight. Doctor Brian Song.
He's a medical doctor who spent most of his career in human biopharma. After observing the high frequency of canine laboratory animal studies conducted as part of human drug development, and the unfortunate lack of veterinary products emerging from these studies, Brian has pivoted his career to bringing the best in canine laboratory research to veterinarians. His first product, Perioviive, is a hyaluronic acid gel adjunct backed by dozens of animal and human studies.
His literature review on the subject was recently published in the Journal of Veterinary Dentistry. Brian has also spearheaded novel clinical trials for hyaluronic acid in gingivitis and stomatitis with research presented at the Veterinary dentist forum. Brian, welcome to the webinar, vet, and it's over to you.
Thank you, Bruce, and thank you everybody for taking the time out of your evening or afternoon or wherever you may be. I am joining from Boston, Massachusetts, where we've had 2.5 ft of snow recently, and it's 3 o'clock in the afternoon here.
So I think, maybe a little earlier in the afternoon than most of our viewers. But, as Bruce mentioned, my background, I am an MD by training, spent a lot of time in human biotech, and yeah, I was there that I made the observation that. There are all these canine laboratory animal studies that were being run as part of human biotech research and development.
That were candidly just going to waste. Veterinarians were just not ever notified or products were never made out of them. And so, that's how I came here today is.
Basically looking through a lot of these canine laboratory animal studies, picking a few that I thought were really good, and then finally picking one that I was going to, you know, sort of bet my career on. And so quit my job, put some savings into it, and we launched it in the end of 2024. It's been growing like a weed ever since, and Hoping to expand that scope to other products and of course other therapeutic areas, so not just dentistry, but potentially into orthopaedics, dermatology, ophthalmology, so on and so forth, .
The bottom line is there's just a lot of canine laboratory animal research out there that should be put to good, to good use for for canine patients and feline patients, but That's the quick background there. Now Hyaluronic acid, it turns out, fits exactly that sort of mould here. It's been studied extensively and in both humans and animals, and there are many human hyaluronic acid products, and Piovibe just happens to be the first in veterinary dentistry.
Now, we're going to go through these topics here, so introduction to HA. We're going to review the literature both in human dentistry and veterinary dentistry. Highlight some new research in veterinary dentistry, and then, I'll have a couple of comments here at the end about how to incorporate it easily into your practise.
But starting with the introduction, so, I think everybody on the call knows what hyaluronic acid is. What you see here is a little organic chemistry. It may start some PTSD for some, but would highlight that it is a naturally occurring biomaterial, so it is ubiquitous across all vertebrate life.
So anybody who's got a backbone has HA in their connective tissue and would just highlight as part of this structure, you know, these brackets represent. The notion that these disaccharide repeats, repeat endlessly to the left and the right, sometimes for hundreds of millions of, of subunits, and we'll get a little bit more into the chemistry in a second here, but would flag that people have known about hyaluronic acid for a long time, so it was first discovered in bovine eyes, so in the vitreous humour back in 1934. Since then, it's been manufactured in many different ways, first as rooster combs, and then more recently, it is sourced via fermentation.
So usually streptococcal species, sometimes yeast species, and it's just more economical and easier to make it that way. And so yeah, you may use hyaluronic acid in many of your products. Already Now, where can you find hyaluronic acid in, in the body?
So, it's most densely present in loose connective tissue. And so you see from this, graphic from Pratt and colleagues. These, these little blue strings are meant to be a cartoon depiction of hyaluronic acid in that loose connective tissue sort of holding everything together and that's not to say that it's not elsewhere.
It's not, you know, it is present in deep fascia muscle and so on and so forth, but this is where it provides the most biologic function, which is in short, it's a scaffolding mechanism. It, it basically serves to hold that loose connective tissue together. And so a whimsical analogy that I like to use is, if you think of your cells as bricks, hyaluronic acid is like the mortar, between the bricks, it's just holding everything together, .
Putting structure to it and making your brick wall strong. So back to the organic chemistry here, . What I've done is I've I've highlighted how it is that it is making things stronger, like why is it sticky and so on, so.
I've highlighted the hydroxyl groups here in orange. These hydroxyl groups stud these long chains of hyaluronic acid, you know, across various angles. You can think of them as Velcro hooks.
These Velcro hooks are literally magnetic. The hydrogens there are donated to negatively charged cell surface receptors, fibrin, platelets, and so on, and that's what gives it its sort of sticky quality. That's what gives it its ability to scaffold extracellular tissue and so on.
And I have here just an AI depiction, a cartoon depiction of how that actually works. So, you know, on the left here you have your hyaluronic acid chains, and they bind via hydrogen bonds to, you know, different cell surface receptors and so on. And you can think of this on, on a massive scale.
Again, hyaluronic acid can be hundreds of millions of subunits long, and, and that's what's providing this structure, this. This mortar between bricks is is the analogy there. So what do you actually get out of this?
So I think the focus in, in the, in the context of dentistry should be on wound healing. So, our patients, our veterinary patients, you know, Oral health is never great, right? There's always very severe periodontitis, a lot of bleeding on probing, and then even the surgery itself, when you go in there and scaling and route planning and so on, you're, you're essentially introducing a wound, replacing a chronic wound with an acute wound.
And so The way to think about this is. High molecular weight HA. Is the initial stabilisation version of HA, and that is degraded into low molecular weight HA which in turn supports scaffolding of the connective tissue.
It's absorbed into that, that connective tissue beneath the epithelium and it supports healing and This process is a natural process. It's actually an essential process for the clotting cascade. So, When you get a cut, the first thing that happens is platelets aggregate.
The second thing that happens is those platelets and epithelial cells in concert will release all of these clotting factors, and you all may remember from your biochemistry, you know, factor 12, factor 8, factor 11, fibrin, fibrinogen, so on. In addition, it's also releasing huge amounts of high molecular weight HA, and what that high molecular weight HA is doing again is it's stabilising that clot. And In, in, in sort of the natural degradation of that clot, it's ultimately also being degraded and absorbed into the surrounding tissue in order to provide many of the mechanisms or benefits that you see on the right hand side.
So, you have sort of this laundry list of things that HA has been shown to promote. I said blood clot stabilisation, you know, once it's inside of the extracellular matrix. You know, it can reduce scars.
It can promote cell migration and so on and so forth. I wouldn't necessarily overthink it as far as this is concerned. It's really just providing stability to an otherwise chaotic situation, and it's enabling other cells to do their job better.
So, you know, you see it's a bacteriostatic effect, right? It's not because hyaluronic acid actually kills bacteria. It's because The the extracellular matrix is more organised and now white cells can more easily migrate to that space and then kill bacteria that way, and so on and so forth.
So I think a lot of this here, and I mentioned here hemostasis and inflammation. Eventually the HA becomes lower molecular weight HA. It's absorbed in the surrounding tissue, and it helps attract these fibroblasts and so on and so forth to the site, angiogenesis as well.
So that's a little bit about the mechanism there. Now, I would say that. People know that this is not just for dentistry.
People are more familiar with it, probably in the context of joints, right? So hyaluronic acid was first used in joints in horses, but it's also now used in veterinary practise in eye care, ophthalmology, wound care. Ear care, and then maybe a lot of people are familiar with it on their skin.
It's a moisturiser, a key component of many moisturisers. And then finally, it's been available in human dentistry for 20 years or so. Now, finally, there's something available for veterinarians and their patients.
So that is the background on the mechanism. Now, let's review some data, right? So I mentioned there's a lot of data in the human side and then of course in the veterinary side, we'll cover some of this data here.
First of all, we just say that. There's a lot of it. There's dozens and dozens of studies across multiple species.
We're talking humans, dogs, mice, rats, sheep, rabbits, cats now, so a lot of, a lot of studies, a lot of peer reviewed studies, and I've just grabbed a few of the abstract titles here. Now I mentioned earlier it supports many of these endogenous functions more via scaffolding. You can see here a nice depiction from Polon and colleagues.
If you put HA specifically in the dental setting, right, so here's your tooth and here's your gingiva and some bone and so on. The HA can sit in that periodontal pocket. It can help stabilise the clot in a sort of larger form format, the high molecular weight, and then it is cut into smaller pieces as part of the healing process, and then it can help support all of these important regenerative processes with fibroblasts and osteoblasts and so on.
And there's a lot of data that supports. You know, these regenerate regenerative properties. I see paradontal ligament here as well.
And then this, this is just meant to depict that because you have a nice healing in the space, you can prevent some bacteria, bacteria from encroaching as well. So I'm going to summarise a few of the highlighted studies here. I think the thing that most people care about is probing depth and clinical attachment.
So of course you want less probing depth and you want more clinical attachment. So what you have here is a number of meta-analyses. So these are You know, a collection of studies that have been statistically analysed, for these statistically significant effects and so, The chart represents probing depth improvement over the standard of care.
So the standard of care in most cases with scaling and root planing, in some cases open flap debridement, but just so that we're clear, this is a statistically significant improvement over the surgery that was already conducted, and you have in Ellie Eiser's case, this was non-surgical. They split it out. This was a surgical, so this was open flap.
And then we have some of these other studies as well showing that you can get improvement in probing death from 0.5 millimetre to 1.5 millimetres across many, many studies.
So these are all meta-analysis and then additionally, you can get clinical attachment levels again on the order of 0, 0.5 to 1 millimetre, again over the standard of care. And, and again, this is a meta-analysis of Multiple, split mouth and double blind and placebo parallel arm studies.
Now, in addition to looking at probing death and clinical attachment, some of these studies also looked at bleeding on probing, which is a nice surrogate for gingivitis, and you see here that they showed the end points are not on here, but I or the time points are not on here. I should have put them on there, 3 to 6 months in reduction of bleeding on probing over standard of care. You see that.
Between 15 and just under 40% reduction in that bleeding on probing score. So there is a long-term anti-gingivitis effect from using hyaluronic acid in dentistry as demonstrated by these studies in humans. I think another thing that's important to highlight is that these, to show how these perform from a single application basis.
So this is most similar to how it will be applied in the veterinary setting. So to be clear, some of these earlier studies showed that, were, were protocol designed to have multiple applications of HA. But we'll just highlight here that if you take out the human studies that only had a single application.
You still get improvement and sometimes you can get in in one study here, a truly tremendous improvement in probing death and clinical attachment. So this is a 12 times improvement over standard of care here from Chan and colleagues, and then a 450%, so 4.5 times improvement in clinical attachment over standard of care.
So. Just wanted to highlight those studies because they are the most similar to, the realistic application process in the veterinary setting. Now, beyond the teeth that you're hoping to save, so these are the ones where you do scaling and root planing, you apply HA and you get reductions in probing depth and so on.
It's also been studied how hyaluronic acid improves healing in the context of extractions. And so you see here in this, in this chart on the left hand side, this is the hyaluronic acid group. On the right hand side this is the control group.
The green represents good or very good tissue healing index, and then the red or the orange represents poor tissue healing index, and you see that in the hyaluronic acid group 7 days post extraction you had between 80% and 90%, you know, just over 85% had good or very good healing versus at the same time point in control patients. You had just over 70% as poor and so the idea here is that, you know, you can massively accelerate healing, certainly at the 7 day standpoint or time point from these extractions. A different study from Shiborna and colleagues showed that this also translates to reduced pain.
So this again was in humans. There is a VAS, a visual analogue scale pain score, where 100 is, you know, the worst pain of your life and 0 is no pain. You see that on post-op day one there's a massive improvement in pain scores here where the blue is treated with HA and the grey is untreated or with control, I should say a placebo, and you see that that statistically significant improvement persists all the way up to day 3 in pain.
So that healing, also represents an important pain end point. And this was triangulated with by in the same study by measuring PRN analgesic consumption. So everyone was blinded to this, so the patients were blinded, the investigators were blinded, and all that was measured was how much pain medication did each cohort take.
And you see here on average in 3 days. And this was tramadol was the medication. The untreated patient arm took 8 tramadols versus just over 5 for the HA treated arm.
So that represents, you know, just, just under 40% decrease in pain medication utilisation. And so A nice benefit there. Lastly, I'd say that beyond just, you know, your Periodontal pockets that you're trying to save, beyond just your extractions where you've taken them out, beyond just sort of like your gingivitis that you're trying to prevent.
There has been many, many other studies on the human side on how this can help as far as, oral pathology. So rattled off here a little table, we have oral nasal fistulas have been studied, phrenectomies have been studied, radiation mucositis, this ulcers or stomatitis. And it's also been studied to be very synergistic with some of these other interventions that you can try in dentistry, so platelet rich fibrin, bone graft, laser, ozone.
When I said that there were dozens of studies on this, I, I was not kidding. There's, there's been a lot. So yes, I, taking a step back here, a lot of data on the human side of things, and the data supports using HA to save more teeth because you can regenerate, a lot of these important tissue types after your typical scaling and root planning and so on.
Also, in the human setting, you're able to justify utilisation and extractions because you accelerate healing, you get your patient back to normal sooner and you provide some pain relief as well. And then finally, the potential to be a signal in all of these other indications here. All right, so that was the human stuff.
What are we really here for? We're here for the veterinary studies, and In this discussion, I'm going to highlight 5 veterinary studies, and I would just make a few points on this summary here. Number 1 is just there's a lot of research out there, right?
Oftentimes for especially veterinary dental products, you would be lucky to get one study, let alone 5 studies. So I think that's the sheer quantity is, is notable. I would also note that these studies, they all didn't look at the same thing.
They looked at a wide variety of indications. So everything from your mild gingival recession to your very severe infected extraction sockets and kind of everything in between, so Class 2 furcations, Class 32 all introverting defects. Last thing I would note is that all these studies were conducted the same way.
It was just a single application of HA, and that was it. No further intervention, no repeat applications, and so on and so forth, which very closely mimics how it would likely be used in a veterinary clinic. One other thing to note All of these studies were designed, split mouth, so.
This is important because it removes a lot of confounding variables, right? Genetics for the patient, diet, and so on and so forth. If it's just the other side of the mouth.
All of these things are held equal. And so this signal, in particular, and this design is, is very important for, giving strength to the evidence here. So that's the summary and, and we're gonna go through all of these little endpoints here now.
So we'll start here with class two furcations. I think this is sort of the most exciting application. This is where many of, many of you out in the audience say to yourself, well, This tooth is on its way out.
It's class toothurcation. Should I bother to save it? I don't know.
This data suggests that maybe you can save more of them, right? And what you see here is a 12-week end point. So this is 3 months after, the dental procedure.
And you see that if you apply a placebo gel, you get tissue regeneration back. You get 30-40% tissue regeneration along bone height, bone area, cementum, ligament. And that's good.
That's why you're doing your scaling and route planning. That's the whole reason you're even doing dentistry. Now what you see here is that if you just apply an HA adjunct, You get double that figure to 80 to 90% regeneration.
And this year is sort of like the the the value proposition in a nutshell, right? It's now. You're getting all this regeneration back and you have this potential to save more teeth, at least in the class 2ificcation setting.
We have many more studies here, so we have a Class 3 furcation study showing improvements at 10 weeks. I would highlight here that they measured junctional epithelium as well as far as regeneration. This is what you don't want, right?
You don't want that kind of disordered, gingival growing back down into your pocket when really you want bone to be back. And so you see here junctional epithelium measured here as well as connective tissue adhesion without cementum, right? So you want your cementum, your periodontal ligament to be nicely attached between new bone and new cementum.
This endpoint. Gives further evidence towards this notion that hyaluronic acid is providing sort of a scaffolding organising effect during this healing process. And so the regeneration that you get is not disorganised regeneration, it's again, nice and organised regeneration.
And then on the right here, you also see new cementum formation, new connective tissue attachment, and so on and so forth. I would, . Well, I'll get back to this in a second, but we'll just note that Class 3 furcations are a relatively severe level of furcational defects, and so when I get to the practical applications point of this, I, I would make a comment on how to take this with a grain of salt, this data.
Additionally, we have two wall intrabony defects here. This was a study that looked at 8 weeks. You see new attachment length.
Just a much larger amount of new attachment length, which is what you want. You want that periodontal ligament attachment, and this is further reflected in periodontal ligament score here. And moving right along, we have endpoint improvements, this should say gingival recession.
Apologies for that, but you see here that you had similar statistically significant improvements across multiple endpoints for gingival recession. So probing pocket death, clinical attachment level, gingival recession, with the gingival recession, these all should be lower and are in favour of hyaluronic acid. And then over here on the right where higher scores are beneficial, so new cementum formation, new attachment formation, new bone formation.
All of these were demonstrated nice statistically significant improvements. Lastly, of the 5 studies here, we have one for. Infected extraction sockets.
So this was a brutal study where they hemisected two rooted molars and They injected those with porphymonas and resulting in a festering infection. From there they extracted and in this setting, they were able to show that you got. Increased mineralized bone, corroborating that earlier healing study in humans, and reduced bone marrow, which is Sort of your undifferentiated tissue that you don't want, right?
You want mineralized bone, when you extract versus your, again, your undifferentiated bone marrow and you see there that controls, are flip-flopped basically. So again, a nice, a nice summary or a nice cross section of different oral, dental pathologies there, and. I think it's important to note that You know, bar charts are nice, but we, we like to see some visual things.
And so, I'm going to share now here some, some visual pieces of data. On the top, this is a flat procedure for a gingival recession. You see at 10 weeks that, you know, you still have your erythema.
You see a basically an unhappy tooth, some plaque formation already. Down at the bottom, you have. That same flat procedure performed just with HA attached and you can see clear as day, a nice difference here.
And as I mentioned earlier, it's important to note that this is the same. Dog, it's just the other side of the mouth. This is another split mouth study.
So this is a nice visual representation. A different way of representing it is in a histology slide. So histology, as, as I believe folks know, is the gold standard for measuring periodontal disease.
And so the way you read this slide here is we have our cartoon depiction of a tooth here, and these arrows are pointing towards the corresponding area in the histology slide. So this is your tooth, and this is your gingiva and bone here. And what you see is A periodontal pocket here.
So you have your 1 millimetre to scale bar, your periodontal pocket is here and would flag that this is 2 months after an open flap debridement. And so this is about, you know, if I'm just eyeballing here, maybe like a 4 millimetre pocket. If you zoom in, you see that this is the apical notch here.
You see you have this stringy, disorganised periodontal ligament. Now, by contrast, if you look over to the right, this is that same flat procedure on the other side of the bilateral, you know, on the other side of the patient. And you see that with HA 2 months post dental.
This pocket has filled in nicely. And if you zoom in further, not only has it filled in nicely, but you see that you have dense. And importantly organised periodontal ligament attaching the new bone to the new cementum here.
And so just by contrast, you have this stringy, you know, it's trying its best, but it is not quite able to get across there. And I think this is really important to note because All of these slides or all of these studies that I've highlighted, all 5 of them took histology, detailed histology across all sites across all patients, so dozens of patients and, and even more individual sites and compared them. So when folks ask, well, how did they figure out the bone height or the cementum height or the periodontal ligament score, right, they did this on a microscopic scale, right?
They did this with histology. The gold standard for measuring and They were able to confirm these nice benefits, and so. Well, I will get onto my soapbox a little bit here and just say that, you know, unfortunately, all of these studies were termination studies.
And so We're able to get data from them because of that sacrifice, and this level of data is otherwise unattainable. And so very important detail there, I think as far as looking at what you're seeing here on the screen. Now, we'll just note that people love a radiograph as well.
So while histology is the gold standard, we have some real-world evidence showing that, you know, hyaluronic acid can result in some nice endpoints here as well. And so on the left here, this is from 2025, and then on the right, this is one year later. And we just flag, I'll draw your attention to this, what appears to be stage 3 periodontitis, you know, call it.
40% bone loss, arguably 50%, right on the border of stage 4. And additionally, you note a bit of a flirtation here as well. On the right-hand side, this is one year later, you're seeing a nice improvement in the periodontitis and then, of course, also the furcation defect.
So this is your 309. Now, on your 409 here, we're seeing. A dramatic furcation here.
You drive a truck through that and you see here, one year later, again, a nice improvement in that furcational defect here radiographically. And so, we'll just flagged that, yes, we have all of these studies, that were conducted in canine laboratory animal studies. And it's nice to see real world experience corroborating that data as well.
So just a couple of radiographs there. Now Finally, we'll, we'll share, as far as the research goes, we'll share some new and ongoing HA research in veterinary dentistry. So, a trial was conducted on feline stomatitis, and so you see here just a nice image showing an improvement in, the inflammation here, especially the caudal inflammation, pre and post.
I'll go into the details just briefly. This, this was presented at the Veterinary Dental Forum in September of last year with the primary investigators, Dr. Bonnie Shope and Dr.
Jamie Anderson. The way this study was conducted is at day one. Patients enrolled in the study were assessed for the stomatitis Disease Activity Index.
And pictures were taken and demographics were taken and consent was signed, and then the first topical application of hyaluronic acid was given to the patient in office. From there, the client went home with some of the products and applied it topically for the remaining 7 days, so day 2 through 7. And then the patient returned to the clinic and stomatitis Disease Activity index score was measured again.
So relatively short study and a relatively simple, design. I would just say that as far as the demographics that came out, this was a highly refractory patient population. So it was 16 patients, half male, half female, average age is 7.5, and, you know, a relatively long lived duration of stomatitis, with the average duration being 22 months.
Half of these patients had already had full mouth extractions and were refractory to full mouth extractions, while another half had teeth remaining, so partial mouth extractions or no extractions at all. Additionally, this, this patient population, . many prior therapies.
So, on average, 2.5 prior medical therapies, including steroids, antibiotics, NSAIDs, and so on and so forth. So, just to give you a sense, it, it was a relatively, refractory population.
Now, what were the results from this, so. 7 days of topical hyaluronic acid applications directly to the lesions resulted in a 75% response rate that you see here. So 12 patients responded, 3 had no change, and 1 did actually get worse.
And then you'll see here that if you analyse statistically the reduction, the mean change in SDII score was 3.7 or 25, just under 25%, improvement. This was a, highly statistically significant finding versus baseline, so P equals 0.007 score and With a just under large Cohen's D effect size of 0.77 versus a large effect size being 0.8.
And, and so again, I, I would just. Reiterate that this is a statistically significant endpoint versus baseline. Now This is hopefully just the beginning.
I'll I'll make one more comment on this, so, you know, we completed this study in stomatitis, hopefully for more studies in the future in things like radiation mucositis, more stomatitis trials, gingivitis, and so on, but yes, excited to share this early stomatitis data here as well, in addition to the other laboratory animal studies and human studies. All right, closing in on the finish here. So, Practical tips So I mentioned at the beginning, You know, there's human evidence showing that it's useful in, you know, your periodontal pockets where you're hoping to save the teeth, in your extraction sockets where you're accelerating healing and providing pain relief, and then additionally in sort of a preventative setting where you are reducing gingivitis in the long run.
This data, as as we went through, is corroborated by some very well conducted canine laboratory animal studies. And so a recommendation or or an inference that you can make is that you can use hyaluronic acid in those analogous studies in your veterinary practise. So, we mentioned extractions here.
The way you do it is you fill an extraction site. Suture first is typically how we do it, although, in some cases if they're large extraction sites, you may want to apply the HA first and then suture over it. Of course, you can apply it as an adjunct to your closed root planing or your open flap debridement.
And then finally, that gingivitis, that prevention of gingivitis justifies utilisation in healthy pockets as well. And so what does this look like? I have a little video here that I'm going to play.
Let's just make sure that she doesn't talk. So what you see in this, video here, they've extracted the 3/11 and sutured over it. You can take the blunt nose applicator tip for this pair of byproducts into the extraction socket and just wait until you see a little bit of it come out.
You would have seen that right there. So a little shininess that came out. Additionally, they scaled and root planned on the adjacent pocket there, and you see they have applied with a blunt nose applicator tip similarly until it's filled up and any excess, you can apply.
Or rub across for an anti-gingivitis effect there. Now, that's for your distractions and pockets. I have here what we're colloquially calling a top off, which is applying it into your healthy subgingital spaces, and so this is just a little video of that as well.
You have your hyaluronic acid being applied there, relatively easy to do, and again, the reason for that is for your anti gingivitis effect. So those are the practicalities of it. I have here a summary.
We just covered what, what did we cover today? So we know that HA, it's a naturally occurring biomaterial. It's essential to many functions.
And today we talked about how it's essential in periodontal healing. Now, exogenous HA, so HA beyond just what your body produces, can be applied and has been shown to, drive better outcomes in both human and veterinary dentistry. And Because of HA's natural binding properties, because of the, of its natural function, it's, it's extremely easy to use.
So you saw those videos just now, there's really not much more to it than that. And then finally, I did mention we have some new and ongoing research, excited to expand on our initial base here, maybe replicate some of those trials that I mentioned in oral nasal fistulas or mucositis and so on, radiation mucositis and so on. And so, hopefully, again, this is just the beginning.
My very last slide here and then we'll get to the Q&A is, you know, if you are interested in trying Piovibe for yourself or hyaluronic acid for yourself in your own practise. We are offering a Free specialist training as part of this webinar. So if you scan the QR code and sign up, it is a 20 to 30-minute virtual call.
It is with a VTS in dentistry, a veterinary technician specialist in dentistry, or a board certified veterinary dentist. They will walk you through the ins and outs of the data, answer any questions. It's often useful to invite your whole team, so your technician team as well, because, generally speaking, this tends to be a technician product.
And You know, as part of this, we're happy to send you a free sample for your, for your participation as a thank you. So, you know, if you're interested in that, please feel free to scan the QR code and, and sign up, through that. OK.
I think I am finally done here. Bruce, any questions coming in from, from the audience here? Yeah, Brian, thank you for sharing this with us, because as veterinarians, we very often don't get to see or hear about all the research that's going on in the background.
So, it's great to know that there is finally some benefit coming from our patients back to us veterinarians instead of all being snuck off to the human side of things, so yeah, that's really good. Fascinating results that you're getting, with the use of it. The, the, most of the questions that are coming in are about the practical use, because some of the studies used it once-off, and there was one other one that kind of used it every day for 7 days.
What would be the recommendation for Perioive as far as frequency and duration of treatment? That's right. And well, I, I, for some of the more clinical questions, I may punt them to my colleague, Dr.
Kristen Linder. She is on the call with us as well. She's a board certified dentist, a veterinary dentist who is on our team, but I'm happy to take this one.
This one's easy. So for general dentistry, so for your periodontal pockets, your extraction sockets, just as an adjunct. A single application under anaesthesia is sufficient, as was demonstrated by, those canine laboratory animal studies and those handful of human studies.
That's not to say that repeat applications is, is not going to potentially get you some more, but I think the vast majority of the benefit has been demonstrated to just be from that single application. Now, for your chronic inflammatory diseases like stomatitis, You know, I, I think we need to do more research on it. I would just say this is sort of where it, it becomes more of an art versus a science as far as medicine, because right now we just don't, we just haven't studied it enough.
What I'd say is that we know for sure that 7 days of Topical applications to your, you know, your, your ulcerative or proliferative stomatitis appears to result in some good benefits, and. It's, it's kind of up to the clinician's judgement on. You know, either whether to continue, whether to taper down the dose, you know, and so on and so forth.
What I, what I would infer or what I am willing to sort of go out on a limb on and say is that it's, it's unlikely that hyaluronic acid cures stomatitis, right? Stomatitiss is a it's a, it's a brutal condition and this has been corroborated with the human equivalent of stomatitis where the hyaluronic acid can provide some relief and and certainly reduce the severity of human stomatitis, but it's not a cure. And so just to be realistic on that front, the silver lining though is that unlike say steroids or cyclosporine or, or things like that.
Hyaluronic acid, can be dosed forever, right? And, and you won't get any adverse events from it. It is a natural biomaterial, so it's very unlikely, that you'll get any toxicities associated with it if you were to dose it chronically.
And we do have some anecdotal evidence of patients who have stayed on this, for well over a year, with, with nice control of their stomatitis, . The last thing I'll say is that we are investigating much more convenient form factors for this application right now. It is a topical application for stomatitis, so either on a, you know, via, you know, you put it onto your finger and apply it directly, sort of like applying hydrocortisone to a mosquito bite.
Or use a Q-tip. We've heard people use Q-tips as well. But in the future, we're, we're hoping to, release a, a much more convenient form factor that, you know, it's still an R&D, so it might be a little too early to talk about, in great detail, but, you know, please, please keep your eyes on, on us as far as, an easier, modality.
So thank you. That was a great question. What else do we have there, Bruce?
Well, I, Brian, you, you, you've given such a great answer that you've actually covered a whole lot of the other questions that have come in as well about, you know, using it at home and home care and that sort of thing. One of the things or questions that has been asked, is, how long would you recommend after you've applied this in your dental treatment, would you recommend that the client waits before brushing, so that they're not damaging the effect of of the Periovibe? So yeah, the nice thing is you can, you know, send them home same day, say good, start brushing, right?
It, it really just depends more on the severity of the procedure than . As far as like resumption of brushing and normal behaviour than it does the HA and, you know, the way to think about it is like. Are you worried about the clot falling out?
Probably not, right? The clot's gonna do its thing no matter what, and HA is part of that clot. It's an essential part of that clot.
And so it's just not, You, you don't really need to worry about, you know, sort of these mechanical things, dislodging it and so on and so forth. And anyway, it's absorbed into the tissue, you know, within 12 hours. So it's underneath the epithelium at that point.
So it's just not, yeah, it's really just not an issue there. Hopefully that helps. Yeah, I think that's an important point that the absorption in, in, you know, is within the 12 hours.
So that's, I think that answers a whole lot of other questions again. . Interesting, question, and I'm not sure if you or or Kristen has the answer, but is the beneficial effect of HA dependent on the patient's age, or is it affected by the patient's age?
Do you find it better in younger or older patients? Ooh, that is one that I have not heard, . Well, I don't know that if that's been studied or not.
What I can say is that, . You know, the HA will be there whether you're old or you're young, right? It is in reduced amounts versus You know, the older you get, the less HA you have in your connective tissue.
It's just sort of one of these things, that, yeah, you know, as your telomeres shorten and whatever, like as you get older, it's just the truth of it. And it's, it's actually why a lot of the HA moisturisers have HA in it. It's to replace the HA that you're losing as you age.
But I don't know, I don't know, I don't know the answer to that one, whether or not HA performs better for older patients versus younger patients, I could not tell you the answer to that one. And I, I, and all the research that I've seen, I, I don't think anybody's specifically looked at it. But what I can say is that there, there have been many studies and they sort of looked at a nice representative cross section, and, and so those averages that come out of there, are, are highly likely to include some older patients.
Yeah, it's, it's all based on, on severity of inflammation and, and, response, I should imagine, because of your classification of your vocation lesions and that sort of thing as well. When the, yeah, with the results and the studies, another common question that's coming through is, did these studies that were done have any form of home care as well, or was it just a single application with no home care afterwards? No home care.
And, and I would just clarify one point is that the, the laboratory canine studies were not done by Piovibe, just to the extent that, you know, having a, a separation as far as conflict of interest goes, you know, we were not the ones that conducted. They were actually conducted across three different academic institutions, one in Korea, one in Japan, one in Egypt, and then, The human studies have been, have been conducted all over. Now, of course, we did our, we, we were the PIs for, or at least the, we were not the PIs but the sponsoring, organisation for the stomatitis study.
But your question, Bruce, again was, was there home care? There was no, there was no home care. Excellent I'll, I'll say just sorry really quick.
Of course you should recommend home care in clinic, right? Like, everybody should be doing home care. That's a very important part of, any, anybody's oral health, so, you know, don't, do not ignore the fundamentals, just because you're, you, you know, now you have Piovive on board.
Of course, you should do, you know, good fundamental surgery, scaling and route planning. Open flap where where relevant. This is a booster of your, your good surgical technique, and not a replacement for by any means, and then, and then, and then still encourage home care, right?
. To the extent possible, right? You know, most of us, even on this call are not really great about home care, but if, if you can get it to happen, then you should. Sorry, Bruce, back to you.
No, that's, that's a very important point. You know, it's not a magic elixir that replaces everything else. You still have to do the basics right, like most things in life.
Sarah was asking a question. You mentioned molecular weight in the beginning. Is the molecular weight of the HA in the product important?
Yes, that's, so that's a great question. So, The molecular weight that is released by platelets in the healing process is high molecular weight, and the molecular weight in periovive closely mimics that same molecular weight, and that's, that's why, you know, these, these products were formulated the way they were way back when, originally 20 years ago, and, you know, we're following suit with our formulation with some notable differences versus the human formulation. You know, a lot of the human formulations have some flavouring and there's Xylitol in them as well.
And, and so it's important that those be removed. And, and I would also note that different molecular weights are used for different purposes in different indications. So, for your moisturisers or for, for your ophthalmologic indications, actually a low molecular weight is preferred because you want that HA to get under the epithelium.
And high molecular weight does not get underneath the epithelium, right? It needs to be broken down first. And so, you know, if you're just applying it to your skin where you have intact epithelium, low molecular weight is preferred.
Same with the cornea. By contrast, if you look at like joint injections for horses, right, what you want there is ultra high molecular weight because you want to maximise the staying power of that HA in the joint capsule. And that provides, you know, for your hydrophilic cushioning and, and, and so on and so forth, in the context of, you know, sort of your osteoarthritis inflammatory situations there.
Back to Pio vibe, there is sort of an important sweet spot as far as you want it to be high enough molecular weight to stick to the clot, stabilise it, but not too high of a molecular weight where it stays forever, right? You, you want it to. Be absorbed into the tissue in concert with the healing process.
If it lingers outside for too long, then, then you, then you basically, Losing out on on the important HA characteristics once it's integrated into that connective tissue. Maybe a little too detailed of an answer, but, no, no, absolutely. No, not, definitely not.
That was perfect. We are running out of time, Brian. I think you have covered most of the questions that have come in.
I think you've covered this as well in during your presentation, but we've had a couple of questions about this. Is this, Periovi safe to use in conjunction with other products like cyclosporins and steroids and NSAIDs and all of those other things that are used often in dentistry? Absolutely, you know, hyaluronic acid is already there, so it's not going to hurt to add more.
And in fact, I would even take it a step further and say that hyaluronic acid has been shown to be synergistic with many of the products you may already use, such as bone graft, you know, maybe Piomix is one, console is another, platelet rich fibrin. These are all products that are already used and, and, yeah, you can get some nice synergy there. Fantastic.
Brian, I, I'm a little bit lost for words. This is, a great revelation for us in dentistry and being a little bit of a closet, dentist myself, I'm very excited about, Perio Vibe being on the market. So thank you to you, and, your products, and thank you to Kristen for joining us this evening and, sharing.
Your knowledge and the insight and all the fantastic research that has gone into making Periovive the product that it is. Thank you, Bruce. If I may, just putting my CEO hat on briefly, you know, again, we, we'd be happy to educate your teams on, on this.
We are available in, in Europe. I know a lot of our audiences in Europe and the UK, so, we are available there, for purchase and the last thing I'd say is that, as far as the economics, you, you will be pleasantly surprised. It is, is, very affordable, and we did that on purpose because we think that this deserves to be used broadly and not necessarily siloed with, you know, your specialists or your, your real dental enthusiasts.
So that, that would be the last thing I'd say. If you have any interest on, on any of this, please reach out, . You can, you can find me at Bryan, B R Y A N at Piovibe.com.
We're always looking for partners for research, happy to answer any questions, and so on and so forth. So thank you very much. I'll hand it back to you, Bruce, for any final thoughts.
Otherwise, thanks Brian, I hope to hear from some of you soon. Yeah, thank you very much for your time. To everybody that attended tonight, thank you for your time as well.
And, I hope you've enjoyed the presentation and I hope you have, Learned something, and scan that, QR code that's up on the screen there, to certainly get some insight into your own journey with Perio Vive. To Dawn, my controller in the background for making everything run smoothly, as always, a huge big thank you. And from myself, Bruce Stevenson, it is good night.
Thank you.
