You know the patient I’m talking about. They come in faithfully for perio maintenance appointments, they’ve genuinely been trying at home with the careful home care instructions you’ve provided, yet the same few sites are still bleeding. Every visit. We review their brushing, re-demo the interdental brushes, re-instrument, and three months later we’re having the same conversation.
I’ve had this hamster-wheel type conversation and scenario more times than I can count, and I always felt I was missing something between visits. One approach that caught my attention is low-concentration peroxide delivered through custom trays.
Why I Kept Coming Back to Hydrogen Peroxide
I’ve been curious about hydrogen peroxide as a post nonsurgical periodontal therapy irrigation option for years. It’s inexpensive and familiar, the chemistry is simple as it breaks down into water and oxygen and essentially makes a pocket an uncomfortable place for the anaerobes behind periodontitis.
A 2022 study in Life by El Mobadder and colleagues deepened that interest.¹ It was designed to look at the 980 nm diode laser and compared four groups with pockets over 5 mm: SRP alone, SRP plus laser, SRP plus 3% peroxide irrigation, and SRP plus both. The peroxide-only group is what caught my eye. Right after treatment, SRP alone cut total bacterial counts by about half. SRP followed by three one-minute rounds of peroxide irrigation cut them by about 87%. At six months, the peroxide group was still well below the SRP-only group, which had drifted back to baseline. 
It’s a retrospective study, it measured bacteria rather than probing depths or bleeding, and the peroxide was delivered by syringe at 3%. Although the study intended to highlight diode lasers, it supported what I’d suspected: peroxide has the potential to do real work in a deep pocket if you can get it there and keep it there.
The Delivery Problem
That was always my frustration in the chair. Hydrogen peroxide needs contact time to break down into oxygen and water, and used as an irrigation solution, my fear was that it washes out with crevicular fluid and saliva quickly. A rinse at home is swished around the whole mouth with little specificity and I wanted it in the specific 6 and 7 mm sites I was worried about.
Where the Tray Comes In
I first heard about Perio Protect on a dental hygiene podcast. It’s a custom tray system that delivers 1.7% hydrogen peroxide gel (Perio Gel) around the teeth and into the pockets. Each tray has an inner peripheral seal that acts like a gasket, pushing the oxygen subgingivally, and is worn for 15 minutes. The delivery design addressed the two questions I kept coming back to: access and contact time. 
The clinical data is encouraging. A randomized, examiner-blind trial of 30 patients with moderate to advanced periodontitis compared SRP alone with SRP plus tray-delivered 1.7% peroxide.² In pockets deeper than 5 mm, the tray group saw about 1 mm of additional probing depth reduction, maintained at six months, along with lower bleeding scores. As I dove deeper into the research, the improvements in clinical parameters were compelling, especially in relation to bleeding reduction, maintained over time.
The Clinical Test
If you are like me, you want to see the results for yourself. The good news is that you don’t need to invest in expensive equipment to find out if it’s worthwhile. The gel can be ordered in small quantities, so pick a few patients with persistent bleeding in deep sites, chart them carefully, and take intraoral photos. Document the response at reassessment and consider it alongside patient compliance.
When you bring it up with a patient, start with their own findings; bleeding, bad breath, frustrations at hygiene visits, then ask where 10 to 15 minutes could fit into their day. One of my favourite compliance boosters is that the gel whitens teeth and eliminates bad breath associated with bacteria. I celebrate the clinical parameter wins, but I can’t help but notice that patients are motivated by their new bright smiles.
I’d love to hear what your charts show. 
Frequently Asked Questions
Does Perio Protect replace scaling and root planing?
No. It’s an adjunct to professional treatment, not a substitute for instrumentation. Perio Tray Studies show that Perio Tray therapy and scaling has a greater reduction in bleeding, pocket depths and inflammation than scaling alone
How is it different from a hydrogen peroxide rinse?
It comes down to delivery. A mouthrinse is not the same as targeted subgingival delivery. The tray is designed to retain the medication while the custom seal is designed to help deliver oxygen below the gingival margin.
How long and how often do patients wear the trays?
The trays are generally worn for 10 to 15 minutes per session, according to the prescribed regimen. Active gingivitis or periodontitis cases may start at twice a day, with the goal of moving to once a day as soon as possible. The goal is to make it as easy as possible, so pick a time of day that is likely to become a habit.
How do I start?
- Step 1: Complete the Perio Protect Provider Form
Perio Protect Provider Form
- Step 2: Create a Curion Account
If you don’t already have a Curion account, you can create one online or call us at 1-800-667-8811 for assistance. - Step 3: Choose Your Starter Pack and Order Gel (2 options)
Perio Protect Starter Packs and Ordering Options
Where can I find more information?
Research and Claims
References:
1)El Mobadder M, Nammour S, Namour M, Namour A, Grzech-Leśniak K. Disinfection potential of 980 nm diode laser and hydrogen peroxide (3%) in “critical probing depths” periodontal pockets: retrospective study. Life. 2022;12(3):370. doi.org/10.3390/life12030370
2) Putt MS, Proskin HM. Custom tray application of peroxide gel as an adjunct to scaling and root planing in the treatment of periodontitis: results of a randomized controlled trial after six months. J Clin Dent. 2013;24(3):100–107.
3) Putt M and Proskin H. Custom Tray Application of Peroxide Gel as an Adjunct to Scaling and Root Planing in the Treatment of Periodontitis: A Randomized, Controlled Three-Month Clinical Trial.
The Journal of Clinical Dentistry. 2012;23(2):48-56.
Written by: Beth Parkes, RDH, BSc,
Manager of Clinical Affairs
beth@curion.ca