Subgingival plaque removal in buccal and lingual sites using a novel low abrasive air-polishing powder

Impact of air-polishing with erythritol on exposed root dentin: A randomized clinical trial

INTRODUCTION

The effects of air-polishing on exposed root dentin surfaces are largely unknown, as there are only few studies which show heterogeneous results. Thus, this study was to investigate roughness changes of exposed dentin surfaces after air-polishing and the influence of subsequent polishing with cup and paste.

METHODS

Totally 54 teeth with exposed root dentin surfaces were treated using a split-mouth design by either air-polishing with erythritol and a rubber cup with polishing paste on the test side, or rubber cup and paste alone. Teeth were finally cleaned using a sonic tooth brush. Impressions were taken at relevant time points and replicated using epoxy resin. The resulting casts were profilometrically analysed to obtain the average surface roughness (sRa) and maximum peak-to-valley height (sRz), which are given as the mean ± standard deviation in μm.

RESULTS

After air-polishing, in comparison to the baseline, there was a slight but significant increase in sRa (0.168 ± 0.143, p < 0.001), but sRz did not change (-0.471 ± 4.857, p = 0.936). Subsequent polishing with cup and paste and cleaning with a sonic toothbrush did not reduce the surface roughness (sonic toothbrush-air-polishing, sRa -0.044 ± 0.081, p = 0.218; sRz -0.551 ± 3.563, p = 0.903).

CONCLUSION

The use of erythritol led to a slight increase in the roughness of the dentin surface, which was not reduced by polishing with a cup and paste. Polishing paste did not seem to conceal surface irregularities.

Comparative study on the effects of different polishing methods on tooth surface microstructure and roughness following initial periodontal treatment

OBJECTIVE

To investigate the effects of different polishing methods on the surface microstructure and roughness of teeth following initial periodontal treatment.

METHODS

Teeth were divided into three groups (silica onegloss, polishing disc, and polishing strip) in vitro. Tooth surface microstructure was characterized via scanning electron microscopy. Roughness was measured by profilometry and laser scanning confocal microscopy (LSCM). According to the in vitro results, one group was chosen for further clinical trials. Effects of the chosen polishing method on patient plaque control and satisfaction were assessed via plaque staining and visual analog scale (VAS).

RESULTS

Electron microscopy results revealed that the polishing disc group had smoother roots and crowns than did the other two groups. Roughness analysis revealed that the crown roughness with the polishing disc and silica onegloss was lower, and the root roughness with the polishing disc was the lowest (p < .05) The LSCM results showed that the pigment deposition depth with the polishing disc and silicon onegloss in the crowns and roots were significantly lower than those with the other two methods (p = .000). The polishing effect of the polishing disc was best among the three groups. Clinical trials were performed to verify the polishing disc effects. Plaque staining results showed that the decrease in plaque in the polishing disc group was greater than that of the rubber cup group (p = .020), which was similar to the results of LSCM. The VAS results showed that the polishing disc made teeth feel smoother, similar to the results of the roughness detection, and the procedure was more comfortable (p < .05). However, there was no significant difference between the two groups regarding foreign body sensation during pronunciation (p = .178).

CONCLUSION

Combining in vitro and in vivo evaluations, the use of a polishing disc following periodontal treatment yielded superior polishing effects on teeth and was better accepted by patients.

Subgingival Use of Air-Polishing Powders: Status of Knowledge: A Systematic Review

Effective subgingival biofilm removal is crucial for achieving positive and stable outcomes in periodontal therapy, forming an indispensable part of any periodontal treatment approach. The development of air-polishing tools has emerged as a promising alternative to hand and ultrasonic scalers for dental biofilm removal. The objective of this systematic review was to assess existing literature regarding the subgingival use of various types of air-polishing powders, as an effective method of subgingival biofilm control. For this, 55 articles on this subjected were sourced from searched databases and subjected to an evaluation process of their contained information, which was subsequently structured and compiled into this manuscript. The existing literature acknowledges that good subgingival biofilm control is essential for the success of periodontal therapy, including through subgingival air-polishing, as an adjunctive procedure. This approach has the potential to enhance patient comfort during and after subgingival mechanical plaque removal, thereby mitigating damage to periodontal structures. Consequently, it may lead to improved healing capabilities within the periodontal tissues and the formation of a more stable reparative gingival junctional epithelium.

The working angle in low-abrasive air polishing has an influence on gingival damage-an ex vivo porcine model

OBJECTIVES

To investigate the influence of instrumentation angle during low-abrasive air polishing (LAA) on the oral gingiva using an ex vivo porcine model.

MATERIAL AND METHODS

Six tissue samples from each of 14 porcine mandibles were randomly selected and instrumented. Two different LAA powders (glycine 25 μm, tagatose 15 μm) were investigated. An application angle of either 30-60° or 90° was selected. Gingival specimens from different mandibles served as untreated references. Gingival biopsies were examined by scanning electron microscopy and paraffin histology for tissue destruction using a five-level scale.

RESULTS

LAA caused significantly less tissue damage at a 90° angle than at a 30-60° angle. This effect was seen in both the glycine-based powder arms (p = 0.002, p = 0.046) and the tagatose-based powder arms (p = 0.003, p = 0.011). However, at identical working angles, the two powders did not show significant differences in terms of gingival erosion (p = 0.79 and p = 0.57; p = 0.91 and p = 0.78, respectively).

CONCLUSIONS

LAA may cause less tissue damage at an application angle of 90°. Consequently, it seems advisable to air-polish the soft tissue as perpendicularly as possible. Additionally, glycine and tagatose LAA powders do not seem to differ in concern of soft tissue damage.

CLINICAL RELEVANCE

Within the limitations of this ex vivo animal model, this study argues for an application that is as close as possible to the 90° angle intending to minimize soft tissue damage. Manufacturer specifications, however, mainly request applications deviating from the right angle. In order to work in interdental areas using LAA safely, the use of subgingival nozzles might be considered.

An In Vitro Evaluation of the Effects of Air-Polishing Powders on Sound and Demineralised Enamel

AIM

To evaluate the effects of two air-polishing powders, during orthodontic treatment, on the surface roughness of sound and demineralised enamel.

MATERIALS AND METHODS

Forty-two caries-free human molars were collected, and the enamel surfaces were flattened and polished. Teeth were assigned to two groups (n = 21 each), a sound- and a demineralised-enamel group (subjected to pH-cycling over 2 weeks to create artificially induced white spot-like lesions). Within each group, teeth were further assigned to three groups (n = 7 each), air polished with either sodium bicarbonate, erythritol, or a negative control (water). Each sample was treated for 5 and 150 s. The average surface roughness (Ra) for each sample was measured using white-light-sensor profilometry.

RESULTS

On sound enamel, the Ra was roughly 0.17 ± 0.07 μm. After 150 s of air polishing, the Ra increased with erythritol (by 0.28 μm), and even more so with bicarbonate treatment (by 0.68 μm) (p < 0.01). On demineralised enamel, the Ra was roughly 0.79 ± 0.56 μm. The Ra increased after 5 s of air-polishing treatment similarly with erythritol and bicarbonate powders (by 1.03 μm and 1.04 μm, respectively) (p = 0.025), and even more after 150 s (by 2.48 μm and 2.49 μm, respectively) (p < 0.001).

CONCLUSIONS

On white spot lesions, one should be aware that enamel surface roughness will increase with both erythritol and bicarbonate air-polishing powders, especially with longer exposure times.

The efficacy of air polishing devices in supportive periodontal therapy: Clinical, microbiological and patient-centred outcomes. A systematic review

OBJECTIVES

The aim of this review was to compare air polishing devices with conventional periodontal therapy (hand instrumentation and/or ultrasonic debridement), in terms of their clinical, microbiological and patient-related outcomes in patients undergoing periodontal maintenance therapy.

METHODS

An online database search was performed to identify randomized controlled trials (RCTs) published between January 1987 and March 2021. Selection, data extraction and assessment risk of individual bias were conducted by two independent reviewers. The PICO method was employed to formulate the question: "In patients undergoing periodontal maintenance therapy/supportive periodontal therapy, do air polishing systems result in better clinical, microbiological and patient related outcomes than ultrasonic instrumentation or hand instrumentation?" Primary outcomes were bleeding on probing, gingival index and/or bleeding index. Secondary outcomes were probing depth, clinical attachment level, plaque index, microbiological counts and/or patient tolerance. The risk of bias was evaluated and the systematic review protocol was registered in PROSPERO.

RESULTS

The electronic search yielded 501 references of which 14 were included in this review. A meta-analysis was not performed due to great heterogeneity within the studies. Air polishing devices and conventional periodontal therapy presented identical results in the 14 studies analysed; however, air polishing devices presented better antimicrobial behaviour and better patient-related outcomes.

CONCLUSIONS

Both air polishing devices and conventional techniques demonstrated no difference in terms of clinical efficacy; however, air polishing devices seem to present improved antimicrobial results. In addition, they are also a safer, faster and more comfortable option for patients undergoing supportive periodontal therapy.

In-vitro influence of the use of an erythritol powder through air polishing on the surface roughness and abrasiveness of various restorative materials

The aim of this in-vitro study is to compare the prophylaxis powder Airflow® Plus to a conventional prophylaxis paste with regards to surface abrasion and roughness on four different restorative materials. A total of 80 samples were fabricated, including 20 of each investigated material. Among those were a nanocomposite (Ceram X Spectra™ ST, Dentsply), a glass ionomer cement (Ketac Fill™, 3M™), a cast metal alloy (Bio Maingold SG®, Heraeus Kulzer) and a ceramic (HeraCeram® Saphir, Heraeus Kulzer). Of each material, all samples were equally divided into two groups. Samples in one group were treated with AirFlow® Plus using the AirFlow® Prophylaxis Master (EMS, Switzerland) (Group AF) and the ones in the other group with Prophy Paste (Cleanic™, Kerr, Austria) (Group CL) on a rubber cup. Applied force amounted to 1.5 N at 2000 rpm. Under controlled reproduceable conditions, a 10-year interval with 4 application per year, a total of 200 seconds, was simulated. Size of each sample amounted to 6 mm in diameter and 2 mm in height. Half side of each sample were treated. While comparing the treated and untreated area of each sample, surface abrasion and roughness were measured using an optical 3D system. Roughness was measured based on the arithmetic roughness average of the surface (Ra) and root mean square of the surface roughness (Rq). The statistical evaluation of the data was carried out using the non-parametric Mann-Whitney-U-test, Wilcoxon-test and the Kruskal-Wallis test for group comparisons. In conclusion, the use of the rubber cup with Prophy Paste caused a significantly higher abrasion on composite, ceramic and gold compared to the AirFlow® Plus powder (p < 0.05). In group AF, the significant highest values for Ra were determined on GIC, followed by composite, gold and then ceramic in intragroup comparison. Ra on GIC was significantly higher in group AF (p < 0.05).

Impact of glycine and erythritol/chlorhexidine air-polishing powders on human gingival fibroblasts: an in vitro study

BACKGROUND

Supra- and subgingival air-polishing has been used in periodontitis and gingivitis therapy for years. Low-abrasive types of powders have facilitated the application in subgingival areas. In this study, the cellular effects of a glycine powder and an erythritol/chlorhexidine (CHX) powder on human gingival fibroblasts (HGF) were investigated.

METHODS

HGF were obtained from sound gingiva of three healthy donors. After 12hours and 24hours of incubation time, cell viability testing and, after 24hours and 48hours, a cell proliferation assay was conducted. Additionally, the individual components erythritol and CHX were investigated for cell viability. In vitro wound healing was monitored for 48hours and scanning electron microscopy (SEM) analysis was performed after 24hours. Statistical analysis was accomplished by ANOVA and post hoc Dunnett's and Tukey's tests (p < 0.05) were performed.

RESULTS

Erythritol/CHX powder and in a lower extent, glycine powder decreased cell viability and cell proliferation. The negative effect of erythritol/CHX was mainly based on the CHX component. In vitro wound healing was negatively influenced in both types of powders compared to control. Cell size was altered in both test groups, whereas cell morphology was affected only in the erythritol/CHX group.

CONCLUSIONS

The investigated powders for subgingival air-polishing can influence cell viability, morphology, and proliferation, as well as wound closure in vitro. These actions on fibroblasts are discernible, with the cytotoxic effect of erythritol/CHX powder being very clear and mainly due to the CHX component. Our results suggest that subgingivally applied powders can exert direct effects on gingival fibroblasts.

The effectiveness of scaling and root planing with combined application of air polishing and Nd:YAG laser in periodontal pockets of stage III grade C periodontitis patients: a single-blinded randomized clinical trial

OBJECTIVES

Evaluating the efficiency of combined air polishing and Nd:YAG laser application in addition to scaling and root planning (SRP) in treatment of periodontal pockets of stage III grade C periodontitis patients was the aim of this clinical trial.

MATERIALS AND METHODS

Twenty-four systemically healthy, stage III grade C periodontitis patients were recruited for this clinical trial. In this split-mouth study, the quadrants were randomly allocated to either SRP with combined air polishing (erythritol/chlorhexidine powder) and Nd:YAG laser (2 W, 200 mJ/pulse, 10 Hz) therapy (test group) or SRP alone (control group). A masked examiner recorded clinical parameters such as plaque index (PI), gingival index (GI), bleeding on probing (%) (BOP %), probing depth (PD), and clinical attachment level (CAL) on periodontal charts at baseline, 1 month and 3 months after treatment.

RESULTS

The clinical parameters had significantly reduced 1 and 3 months after treatment compared to baseline for both study groups (p < 0.05). Considering PI, GI, and BOP (%) parameters, there were no significant differences between the study groups at any time points (p > 0.05). While PD and CAL reductions were similar in study groups for moderately deep pockets (5 to 6 mm) (p > 0.05), PD and CAL reductions were significantly greater in test group compared to control group for deep pockets (PD ≥ 7 mm) (p < 0.05).

CONCLUSIONS

The present clinical trial demonstrated that SRP with combined application of air polishing and Nd:YAG laser may be advantageous in sites where mechanical debridement alone cannot access, such as deep pockets in the short term. Long-term, well-designed future studies including clinical, biochemical, and microbiological analyses are needed to determine the effectiveness of this procedure.

CLINICAL RELEVANCE

SRP with combined application of air polishing and Nd:YAG laser provided more reductions in probing depth and clinical attachment level parameters in deep pockets compared to SRP alone.

Efficacy of air polishing in comparison with hand instruments and/or power-driven instruments in supportive periodontal therapy and implant maintenance: a systematic review and meta-analysis

BACKGROUND

Supportive periodontal therapy (SPT) is the key for a stable periodontal health following active treatment. Likewise, implant maintenance is crucial following implant placement. This systematic review aimed to assess clinical outcomes, patients' perception, and cost-effectiveness of repeated periodontal therapy with air polishing devices (APDs) in comparison with hand instruments and/or power-driven instruments (conventional interventions) in SPT and implant maintenance.

METHODS

Electronic search for randomised controlled clinical trials with minimum 6 months follow-up for SPT and implant maintenance programme was conducted for data published from 01 January 2000 to 30 April 2020 using multiple databases and hand searching. Risk of bias was assessed using the Revised Cochrane Risk-of-Bias tool (RoB 2).

RESULTS

A total of 823 articles were screened. 4 SPT and 2 implant maintenance studies were eligible for inclusion. For SPT, repeated APDs interventions revealed no statistically significant difference when compared to the conventional interventions (weighted mean difference [WMD] 0.11 mm, p = 0.08). Likewise, no statistical difference was noted in terms of percentage of bleeding on probing (BOP) and clinical attachment level (CAL) gain. APDs were associated with lower pain score (based on Visual Analogue Scale) and higher patient acceptance in SPT studies. For implant maintenance, APDs resulted in reduction in PPD and percentage of BOP. However, CAL gain was comparable between the two groups. In terms of patient reported outcomes, no implant maintenance studies recorded any forms of patient reported outcomes. In addition, no studies reported on economic evaluation of APDs in both SPT and implant maintenance.

CONCLUSION

Within the limitations of this systematic review and meta-analysis, repeated subgingival debridement using APDs in SPT resulted in similar clinical outcomes but better patients' comfort when compared to the conventional interventions. For implant maintenance, there is limited evidence to show that repeated application of APDs leads to improved clinical outcomes when compared to conventional treatments.

Subgingival air polishing with trehalose powder during supportive periodontal therapy: use of a conical shaped tip during a randomized clinical trial

Background

This study investigated clinical parameters using a new air-polishing device compared to sonic scaling for subgingival biofilm removal during supportive periodontal therapy. The aim was to evaluate noninferiority of air-polishing compared to sonic scaling in deeper periodontal pockets with respect to pocket depth (PD).

Methods

In 44 participants, 2 single-rooted teeth [(PD) ≥ 5 mm] were treated using a split-mouth design. While a new air polishing device with a conical shaped tip was used for the experimental group, sonic scaling was performed in the control group. PD, clinical attachment level (CAL), and bleeding on probing (BOP) were recorded at baseline, (T0) after 3 months (T1) and 6 months (T2). Pain perception was rated using a visual analog scale (VAS; 0 = no pain, 100 = maximum pain).

Results

PD and CAL decreased significantly for both groups, while no intergroup differences were found (PD [mean, mm] control T0 5.96, T2 4.75; experimental T0 5.96, T2 4.8; intergroup p = 0.998; CAL [mean, mm] control T0 7.38, T2 5.84; experimental T0 7.28, T2 6.34; intergroup p = 0.368). For BOP, no intergroup differences were found from T0 to T2 (reduction control 42.5%; experimental 46.5% p = 0.398). Pain perception was significantly lower for air polishing (VAS [mean, mm] control 28.8, experimental 12.56; p = 0.006).

Conclusion

None of the two treatment procedures showed inferior clinical effects with regard to PD, CAL and BOP with air polishing being more comfortable to patients.

Trial registration The study was registered in an international trial register on August 14/08/2019, before the start of recruitment (German Clinical Trial Register number DRKS00017844).

Antimicrobial Impact of Different Air-Polishing Powders in a Subgingival Biofilm Model

Subgingival air-polishing devices (SAPD) can reduce bacterial biofilms and thus support periodontal healing. The authors of this study evaluated the effectiveness of the glycine-based and trehalose-based air-polishing powders in removing pathogenic bacteria in a subgingival biofilm model. We treated 56 subgingival pockets in porcine jaws with SAPD. Subgingival air polishing was performed in three groups of 13 pockets each: I, glycine-based powder; II, trehalose-based powder; and III, water alone. Another group (IV) served as untreated controls. Prior to air polishing, inoculated titanium bars were inserted into the pockets containing periopathogenic bacteria such as Porphyromonas gingivalis and Tannerella forsythia. Remaining bacteria were evaluated using real-time PCR. The numbers of remaining bacteria depended on the treatment procedure, with the lowest number of total bacteria in group I (median: 1.96 × 10⁶ CFU; min: 1.46 × 10⁵; max: 9.30 × 10⁶). Both polishing powders in groups I and II (median: 1.36 × 10⁷ CFU; min: 5.22 × 10⁵; max: 7.50 × 10⁷) showed a statistically significantly lower total bacterial load in comparison to both group IV (median: 2.02 × 10⁸ CFU; min: 5.14 × 10⁷; max: 4.51 × 10⁸; p < 0.05) and group III (median: 4.58 × 10⁷ CFU; min: 2.00 × 10⁶; max: 3.06 × 10⁸; p < 0.05). Both subgingival air-polishing powders investigated can reduce periopathogenic bacteria and thus support antimicrobial therapy approaches in periodontal treatment regimens.

Comparison of the effect of sodium bicarbonate and glycine air polishing systems on tooth surface roughness: An atomic force microscopic analysis

BACKGROUND

A variety of prophylactic materials are used in the dental office for the removal of stains and calculus.

OBJECTIVE

To evaluate tooth surface changes caused by the application of air abrasive powders (sodium bicarbonate, SBAP and glycine air powder, GPAP) along with scaling and root planing (SRP), under atomic force microscope (AFM) and to analyze the histological soft tissue changes caused by these agents, using light microscopy.

METHODS

This study was conducted in two phases: in vitro and in vivo. In the in vitro phase, hard tissue analysis was done under AFM following air powder polishing. Eighteen extracted teeth were chosen. SRP and tooth sectioning were carried out. Subsequently, each section of the tooth was mounted on a glass plate with self-cure acrylic resin and air polished using SBAP and GPAP. In the vivo phase, the soft tissue was analyzed under a light microscope for surface roughness. A biopsy specimen was taken from patients who had received phase I therapy, and flap surgery was planned using a modified Widman flap technique.

RESULTS

This study compared surface changes in enamel and cementum, under AFM, as indicated by RA after SRP, SRP and SBAP, and SRP and GPAP; comparisons were then drawn across the three groups. The mean AFM values were 108.5 and 144.7, 102.7 and 81.7, and 95.6 and 7.4, at the crown and root, for SRP, SRP and SBAP, and SRP and GPAP interventions, respectively. GPAP was the least rough on soft tissues.

CONCLUSION

SBAP and GPAP were better than hand instrumentation as indicated by AFM and histological section analysis.

Cellular effects of glycine and trehalose air-polishing powders on human gingival fibroblasts in vitro

Objectives

Air-polishing has been used in the treatment of periodontitis and gingivitis for years. The introduction of low-abrasive powders has enabled the use of air-polishing devices for subgingival therapy. Within the last decade, a wide range of different low-abrasive powders for subgingival use has been established. In this study, the effects of a glycine powder and a trehalose powder on human gingival fibroblasts (HGF) were investigated.

Methods

HGF were derived from three systemically and periodontally healthy donors. After 24 h and 48 h of incubation time, mRNA levels, and after 48 h, protein levels of TNFα, IL-8, CCL2, and VEGF were determined. In addition, NF-κB p65 nuclear translocation and in vitro wound healing were assessed. Statistical analysis was performed by ANOVA and post hoc Dunnett’s and Tukey’s tests (p < 0.05).

Results

Glycine powder significantly increased the expression of proinflammatory genes and showed exploitation of the NF-κB pathway, albeit trehalose powder hardly interfered with cell function and did not trigger the NF-κB pathway. In contrast to trehalose, glycine showed a significant inhibitory effect on the in vitro wound healing rate.

Conclusion

Subgingivally applicable powders for air-polishing devices can regulate cell viability and proliferation as well as cytokine expression. Our in vitro study suggests that the above powders may influence HGF via direct cell effects. Trehalose appears to be relatively inert compared to glycine powder.

Clinical relevance

With the limitations of an in vitro design, our study suggests that in terms of cell response, trehalose-based air-polishing powders show a reduced effect on inflammation.

Clinical outcomes of performance of dental students using erythritol powder by means of air polishing with ultrasonic debridement with students' assessment: Part II

OBJECTIVE

Assessment of a dental student's clinical performance is essential for providing feedback for improving education. This study evaluated the ability of undergraduate dental students to treat periodontal patients with two techniques, ultrasonic debridement with polishing (UD+P) and the erythritol powder air polishing with ultrasonic instrumentation (EPAP+UD) in a split-mouth design.

METHODS

The study was conducted on undergraduate students with patients suffering from gingivitis and stage I periodontitis with grade A. The evaluation consisted of two parts: first, assessment of the student by clinical indices (full mouth plaque index (FMPI), calculus index (CI), remaining calculus index (RCI), modified gingival index (MGI) and papillary bleeding index (PBI)) at baseline, immediately and after 2 weeks. In addition to assessing treatment time for each student; and second, obtaining student feedback about the two methods used.

RESULTS

Five undergraduate fourth years' students, and thirteen patients participated. Statistically significant decreases in FMPI, CI, MGI and PBI between baseline and 2 weeks post-treatment were noted in both test and control groups. At 2 weeks of inter-group comparisons, there was a statistically significant difference in FMPI and MGI indices, and immediately after the treatment, there was also a significant reduction in FMPI and CI. Treatment time was significantly less for the EPAP+UD method, and it got 10-time method preferring in comparison with the control group (UD+P) by students.

CONCLUSION

The undergraduate dental student has the capacity to treat the periodontal patient using both approaches with a preference for the EPAP+UI approach over UI+P. In addition, this EPAP+UI is a promising method of education.

Clinical outcomes of using erythritol powder by means of air polishing with ultrasonic debridement in the treatment of initial periodontal pockets in hand of dental students: A split-mouth, randomized, comparative, controlled study. Part I

OBJECTIVE

The purpose of this trial was to evaluate the clinical efficacy and patient acceptance of using the erythritol powder air polishing with mechanical debridement in non-surgical periodontal therapy.

METHODS

The trial was conducted as a split-mouth design study of 6 weeks' duration including 13 patients with gingivitis and stage I periodontitis with grade A. Each patient received ultrasonic debridement and polishing (UD+P) on one side, whereas the contralateral side was treated by erythritol powder air polishing and ultrasonic instrumentation (EPAP+UI) when required. Clinical variables were as follows: papillary bleeding index (PBI), bleeding on probing (BOP), full mouth plaque index (FMPI), calculus index (CI), modified gingival index (MGI), probing pocket depth (PPD), the time needed and rate the pain for each group.

RESULTS

The FMPI, MGI, CI, PBL and BOP parameters improved significantly for both treatment procedures; however, there were no statistically significant differences between the two groups at any of the examinations intervals, except for MGI and CI which showed a significant reduction at 2 weeks compared with baseline. PPD was significantly decreased in EPAP+UI group. Perceived pain intensity was lower for EPAP+UI group than UD+P group without any significant difference during follow-up periods between the two groups. Seven patients favoured air polishing. The treatment's time was (24.92 ± 9.260 and 34.08 ± 9.106) minutes for the test and control side, respectively.

CONCLUSION

This study generally revealed no significant differences in clinical outcomes between two groups for gingivitis and stage I periodontitis treatment. However, EPAP+UI had higher patient's preference and less time-consuming compared with UD+P.

Effectiveness and safety of a new dental plaque removal device utilizing micro mist spray for removing oral biofilm in vitro

Background

Removal of oral biofilm from the oral mucosa is essential for preventing risk of respiratory and gastrointestinal infection in elderly people. Currently, no device is available which can remove oral biofilm from oral mucosa effectively and safely. Therefore, the effectiveness and safety of the Micro Scale Mist UNIT (MSM-UNIT), a newly developed dental plaque removal device utilizing high speed sprays of fine water droplets, were evaluated for biofilm removal, including the rate and surface roughness for simulated tooth surface and mucous membrane.

Methods

Simulated tooth and oral mucosa coated with an artificial biofilm of Streptococcus mutans were used for evaluation of effectiveness, with uncoated substrates as the controls. The MSM-UNIT and a conventional air ablation device were operated under recommended instructions. The effectiveness was evaluated from the rate of removal of the biofilm, and the safety was evaluated from the damage observed by scanning electron microscope and surface roughness.

Results

The biofilm removal rate of the MSM-UNIT was significantly higher than that of AIRFLOW. Little damage was observed in the area treated by the MSM-UNIT. The surface roughness of the MSM-UNIT treated area on simulated tooth surface and oral mucosa showed no significant difference to the control area. In contrast, cracks and powder were observed in the area treated by AIRFLOW. In particular, the surface roughness of the AIRFLOW treated area for Toughsilon was significantly larger than that of the control.

Conclusions

The MSM-UNIT could be used safely and effectively for removing biofilm not only on simulated tooth surfaces but also simulated mucous membrane. The MSM-UNIT has no harmful effect on teeth or oral mucosa, and may be used for comprehensive oral care for patients during nursing care and the perioperative period.

Clinical, inflammatory and microbiological outcomes of full-mouth scaling with adjunctive glycine powder air-polishing: A randomized trial

AIM

To determine the effects of glycine powder air-polishing (GPAP) as an adjunct to full-mouth scaling and root planing (SRP) on clinical, inflammatory and microbiological outcomes in patients with untreated periodontitis.

MATERIALS AND METHODS

Forty-one patients were randomly assigned to the control group A (SRP) and test groups B1 (subgingival GPAP right after SRP) and B2 (subgingival GPAP right before SRP). Clinical examinations and sample collections (saliva, subgingival plaque, serum and gingival crevicular fluid) were performed at assessment visits and before therapies at clinical visits of baseline, 6-week and 3-month. C-reactive protein, IL-6 and TNF-α were assessed in serum and gingival crevicular fluid, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum were measured in saliva and subgingival plaque.

RESULTS

Patients in control and test groups did not significantly differ by age, sex and disease severity at baseline. Participants in control and intervention groups had similar improvements in clinical parameters (PD, BOP, PLI and BI). All groups had a similar percentage of sites showing PD reduction of ≥2 mm between baseline and follow-up visits, with a few exceptions. Reduced C-reactive protein, IL-6 and TNF-α in serum were found after treatments.

CONCLUSION

Full-mouth SRP with and without GPAP resulted in largely similar clinical, inflammatory and microbiological outcomes in the care of untreated periodontitis.

A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy

Background

Due to complex morphology and limited access, the cleaning of the furcation area is extremely challenging. Therefore, novel therapeutic approaches need to be tested to potentially overcome debridement limitations. The aim of the present prospective 12-month study was to compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.

Methods

Twenty patients with grade II mandibular molar furcation defects volunteered to enroll in this single-centre, examiner masked, randomized controlled trial. In a split-mouth study design, two furcation sites in each patient were randomly assigned to either receive subgingival debridement using erythritol air-polishing (test) or conventional ultrasonic/curette debridement (control) at baseline, and at 3, 6, 9 and 12 months. Probing depth, clinical attachment level and bleeding on probing were recorded at 3-month intervals. Subgingival microbiological samples obtained at baseline, 6 and 12 months were analyzed using checkerboard DNA–DNA hybridization. Discomfort from treatment was scored at 12 months using a visual analogue scale. The differences between treatments, and time-points, were tested using multilevel analysis (mixed effect models and robust variance estimates).

Results

A significant reduction in probing depth took place following both treatments (p < 0.001). Control sites experienced a significant mean gain in clinical attachment level of 0.5 mm (± 0.2) (p = 0.004), whereas a non-significant gain of 0.4 mm (± 0.3) was observed at test sites (p = 0.119). At 6 months, a significant between-treatment difference of 0.8 mm (± 0.4) was observed in favor of the control (p = 0.032). No significant between-treatment differences were observed in microbial load or composition. Notably, at 12 months patients experienced significantly less discomfort following air-polishing compared with control (p = 0.001).

Conclusions

The 12-month observations indicate that erythritol air-polishing and conventional mechanical debridement both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favour of control debridement at 6 months. In terms of patient comfort, erythritol air-polishing is superior.

Trial Registration: The clinical trial was retrospectively registered in ClinicalTrial.gov with registration NCT04493398 (07/28/2020).

Evaluation of Antimicrobial Effect of Air-Polishing Treatments and Their Influence on Human Dental Pulp Stem Cells Seeded on Titanium Disks

Dental implants are one of the most frequently used treatment options for tooth replacement, and titanium is the metal of choice due to its demonstrated superiority in resisting corrosion, lack of allergic reactions and mechanical strength. Surface roughness of titanium implants favors the osseointegration process; nevertheless, its topography may provide a suitable substrate for bacterial biofilm deposition, causing peri-implantitis and leading to implant failure. Subgingival prophylaxis treatments with cleansing powders aimed to remove the bacterial accumulation are under investigation. Two different air-polishing powders—glycine and tagatose—were assayed for their cleaning and antimicrobial potential against a Pseudomonas biofilm and for their effects on human dental pulp stem cells (hDPSCs), seeded on sandblasted titanium disks. Immunofluorescence analyses were carried out to evaluate cell adhesion, proliferation, stemness and osteogenic differentiation. The results demonstrate that both the powders have a great in vitro cleaning potential in the early period and do not show any negative effects during hDPSCs osteogenic differentiation process, suggesting their suitability for enhancing the biocompatibility of titanium implants. Our data suggest that the evaluated cleansing systems reduce microbial contamination and allow us to propose tagatose as an adequate alternative to the gold standard glycine for the air-polishing prophylaxis treatment.

Efficacy of the additional use of subgingival air polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial

OBJECTIVES

To date, scarce evidence exists around the application of subgingival air polishing during treatment of severe periodontitis. The aim of this study was to evaluate the benefits of subgingival air polishing during non-surgical treatment of deep bleeding pockets in stages III-IV periodontitis patients MATERIALS AND METHODS: Forty patients with stages III-IV periodontitis were selected, and pockets with probing depth (PD) 5-9 mm and bleeding on probing (BoP) were selected as experimental sites. All patients underwent a full-mouth session of erythritol powder supragingival air polishing and ultrasonic instrumentation. Test group received additional subgingival air polishing at experimental sites. The proportion of experimental sites shifting to PD ≤ 4 mm and no BoP at 3 months (i.e., non-bleeding closed pockets, NBCPs) was regarded as the primary outcome variable.

RESULTS

The proportion of NBCP was comparable between test and control group (47.9 and 44.7%, respectively). Baseline PD of 7-9 mm, multi-rooted teeth and the presence of plaque negatively influenced the probability of obtaining NBCP.

CONCLUSIONS

The additional application of subgingival air polishing does not seem to provide any significant clinical advantage in achieving closure at moderate to deep bleeding pockets in treatment of stages III-IV periodontitis patients. The study was registered on Clinical Trials.gov (NCT04264624).

CLINICAL RELEVANCE

While air polishing can play a role in biofilm removal at supragingival and shallow sites, ultrasonic root surface debridement alone is still the choice for initial treatment of deep bleeding periodontal pockets.

Efficacy of glycine powder air-polishing in supportive periodontal therapy: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis was conducted to assess the effects of glycine powder air-polishing (GPAP) in patients during supportive periodontal therapy (SPT) compared to hand instrumentation and ultrasonic scaling.

METHODS

The authors searched for randomized clinical trials in 8 electronic databases for relevant studies through November 15, 2019. The eligibility criteria were as follows: population, patients with chronic periodontitis undergoing SPT; intervention and comparison, patients treated by GPAP with a standard/nozzle type jet or mechanical instrumentation; and outcomes, bleeding on probing (BOP), patient discomfort/pain (assessed by a visual analogue scale [VAS]), probing depth (PD), gingival recession (Rec), plaque index (PI), clinical attachment level (CAL), gingival epithelium score, and subgingival bacteria count. After extracting the data and assessing the risk of bias, the authors performed the meta-analysis.

RESULTS

In total, 17 studies were included in this study. The difference of means for BOP in patients who received GPAP was lower (difference of means: -8.02%; 95% confidence interval [CI], -12.10% to -3.95%; P<0.00001; I²=10%) than that in patients treated with hand instrumentation. The results of patient discomfort/pain measured by a VAS (difference of means: -1.48, 95% CI, -1.90 to -1.06; P<0.001; I²=83%) indicated that treatment with GPAP might be less painful than ultrasonic scaling. The results of PD, Rec, PI, and CAL showed that GPAP had no advantage over hand instrumentation or ultrasonic scaling.

CONCLUSIONS

The findings of this study suggest that GPAP may alleviate gingival inflammation more effectively and be less painful than traditional methods, which makes it a promising alternative for dental clinical use. With regards to PD, Rec, PI, and CAL, there was insufficient evidence to support a difference among GPAP, hand instrumentation, and ultrasonic scaling. Higher-quality studies are still needed to assess the effects of GPAP.

Applying nano-HA in addition to scaling and root planing increases clinical attachment gain

Purpose

This study evaluated the efficacy of treating periodontitis using subgingival nano-hydroxyapatite powder with an air abrasion device (NHAPA) combined with scaling and root planing (SRP).

Methods

A total of 28 patients with stage III periodontitis (grade B) were included in this study, although 1 was lost during follow-up and 3 used antibiotics. The patients were divided into a test group and a control group. All patients first received whole-mouth SRP using hand instruments, and a split-mouth approach was used for the second treatment. In the test group, the teeth were treated with NHAPA for 15 seconds at 70% power per pocket. Subgingival plaque samples were obtained from the 2 deepest pockets at the test and control sites before treatment (baseline) and 3 months after treatment. The full-mouth plaque index (PI), gingival index (GI), papillary bleeding index (PBI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) were recorded at baseline and at 1- and 3-month post-treatment. Real-time polymerase chain reaction was used to determine the colonisation of Treponema denticola (Td), Porphyromonas gingivalis (Pg), and Aggregatibacter actinomycetemcomitans in the subgingival plaque.

Results

From baseline to the first month, the test group showed significantly larger changes in BOP and CAL (43.705%±27.495% and 1.160±0.747 mm, respectively) than the control group (36.311%±27.599% and 0.947±0.635 mm, respectively). Periodontal parameters had improved in both groups at 3 months. The reductions of PI, GI, BOP, PD, and CAL in the test group at 3 months were greater and statistically significant. The total bacterial count and Td and Pg species had decreased significantly by the third month in both groups (P<0.05).

Conclusions

Applying NHAPA in addition to SRP improves clinical periodontal parameters more than SRP alone. Subgingival NHAPA may encourage clot adhesion to tooth surfaces by increasing surface wettability.

Bio-Inspired Systems in Nonsurgical Periodontal Therapy to Reduce Contaminated Aerosol during COVID-19: A Comprehensive and Bibliometric Review

Background: On 30 January 2020, a public health emergency of international concern was declared as a result of the new COVID-19 disease, caused by the SARS-CoV-2 virus. This virus is transmitted by air and, therefore, clinical practices with the production of contaminant aerosols are highly at risk. The purpose of this review was to assess the effectiveness of bio-inspired systems, as adjuvants to nonsurgical periodontal therapy, in order to formulate bio-inspired protocols aimed at restoring optimal condition, reducing bacteremia and aerosols generation. Methods: A comprehensive and bibliometric review of articles published in English. Research of clinical trials (RCTs) were included with participants with chronic or aggressive periodontal disease, that have compared benefits for nonsurgical periodontal therapy (NSPT). Results: Seventy-four articles have been included. For probing depth (PPD) there was a statically significant improvement in laser, probiotic, chlorhexidine groups, such as gain in clinical attachment level (CAL). Bleeding on probing (BOP) reduction was statistically significant only for probiotic and chlorhexidine groups. There were changes in microbiological and immunological parameters. Conclusions: The use of bio-inspired systems in nonsurgical periodontal treatment may be useful in reducing risk of bacteremia and aerosol generation, improving clinical, microbiological and immunological parameters, of fundamental importance in a context of global pandemic, where the reduction of bacterial load in aerosols becomes a pivotal point of clinical practice, but other clinical trials are necessary to achieve statistical validity.

Retrospective analysis of the long-term effect of subgingival air polishing in supportive periodontal therapy

AIM

Glycine powder air polishing (GPAP) procedure has become popular. Aim of the analysis was to compare the clinical outcomes during supportive periodontal therapy (SPT) of subgingival application of GPAP with those using sole conventional mechanical debridement (SC).

MATERIAL AND METHODS

Over a median SPT period of 5.3 years (re-evaluation through last observation), the GPAP cohort (n = 263) received supra- and subgingival biofilm removal with GPAP. Supragingival calculus was removed using curets and sonic scalers here. Patients in the SC cohort (n = 264) were treated with sonic scalers, curets and rubber cup polishing only. Changes in, that is pocket probing depth (PPD) and furcation involvement were assessed retrospectively. A bootstrapping equivalence testing method in line with the principle of the two one-sided tests (TOST) procedure was used to compare clinical outcomes.

RESULTS

The GPAP procedure was statistically equivalent to SC regarding the number of sites with stable PPDs (83.3%; IQR 68.8%, 91.0% vs. 84.0%; IQR 77.8%, 90.0%). However, in the GPAP cohort, a trend towards deterioration in furcation status (no equivalence) was noted.

CONCLUSIONS

In periodontal maintenance, the use of GPAP instead of mechanical plaque removal does not improve the clinical outcome. It seems to be contraindicated to treat furcation defects with GPAP only.

Clinical outcomes following periodontal surgery and root surface decontamination by erythritol-based air polishing. A randomized, controlled, clinical pilot study

Aim

To evaluate the outcomes following surgical periodontal treatment and root surface decontamination by means of air polishing using an erythritol powder or conventional mechanical root debridement.

Material and methods

Thirty systemically healthy patients (44.38 ± 8.2 years old, 11 smokers, 19 women) diagnosed with periodontitis stages III–IV were included. Each patient, with one single-rooted tooth, with one probing pocket depth (PD) ≥ 6 mm associated with horizontal bone loss, was treated by means of simplified papilla preservation flap (SPPF) and randomized to either test treatment (careful removal of the calculus with the tip of a blade, air polishing of the root surfaces with erythritol) or to the control group (scaling and root planing with hand curettes, ultrasonic instruments). PD, clinical attachment (CAL), bone sounding (BS), and radiographic bone level (BL) were evaluated at baseline and 12 months postsurgically.

Results

Twenty-seven patients completed the 12-month follow-up (test: n = 14, control: n = 13). In both groups, statistically significant improvements were obtained (p < 0.05, mean CAL gain/PD reduction: test, 2.50 ± 1.60 mm/3.00 ± 0.96 mm; control, 2.85 ± 1.21 mm/3.38 ± 1.12 mm). No statistically significant differences were observed between the groups for any of the investigated parameters (p < 0.05).

Conclusion

Within their limits, the present results indicate that the use of air polishing with an erythritol powder during periodontal surgery may represent a valuable minimally invasive adjunct following calculus removal by means of hand and ultrasonic instruments or a valuable alternative to these, for root surfaces without calculus.

Clinical relevance

The use of air polishing with an erythritol powder during periodontal surgery appears to represent a valuable minimally invasive adjunct following calculus removal by means of hand and ultrasonic instruments or a valuable alternative to these, for root surfaces without calculus.

In vitro surgical and non-surgical air-polishing efficacy for implant surface decontamination in three different defect configurations

Objectives

Evaluation of surgical and non-surgical air-polishing in vitro efficacy for implant surface decontamination.

Material and methods

One hundred eighty implants were distributed to three differently angulated bone defect models (30°, 60°, 90°). Biofilm was imitated using indelible red color. Sixty implants were used for each defect, 20 of which were air-polished with three different types of glycine air powder abrasion (GAPA1–3) combinations. Within 20 equally air-polished implants, a surgical and non-surgical (with/without mucosa mask) procedure were simulated. All implants were photographed to determine the uncleaned surface. Changes in surface morphology were assessed using scanning electron micrographs (SEM).

Results

Cleaning efficacy did not show any significant differences between GAPA1–3 for surgical and non-surgical application. Within a cleaning method significant (p < 0.001) differences for GAPA2 between 30° (11.77 ± 2.73%) and 90° (7.25 ± 1.42%) in the non-surgical and 30° (8.26 ± 1.02%) and 60° (5.02 ± 0.84%) in the surgical simulation occurred. The surgical use of air-polishing (6.68 ± 1.66%) was significantly superior (p < 0.001) to the non-surgical (10.13 ± 2.75%). SEM micrographs showed no surface damages after use of GAPA.

Conclusions

Air-polishing is an efficient, surface protective method for surgical and non-surgical implant surface decontamination in this in vitro model. No method resulted in a complete cleaning of the implant surface.

Clinical relevance

Air-polishing appears to be promising for implant surface decontamination regardless of the device.

Effects of subgingival air-polishing with trehalose powder on oral biofilm during periodontal maintenance therapy: a randomized-controlled pilot study

Background

This pilot study was part of a larger study which compared the effect of subgingival air-polishing using trehalose powder with sonic scaling on clinical parameters during supportive periodontal therapy. Within this microbiological part of the investigation subgingival samples were taken from 10 participants to analyze the survival of different bacterial species after the two different treatments as a proof of principle.

Methods

In 10 participants two non-adjacent, single-root teeth requiring treatment (PD =5 mm with bleeding on probing (BOP) or > 5 mm) were selected following a split-mouth design and were treated either with a sonic scaler or air-polishing device and trehalose powder. For persistent pockets (PD =4 mm and BOP or > 4 mm), treatment was repeated after 3 months. Subgingival biofilm samples were taken at baseline (BL), subsequently and three and six months after treatment. After determination of the bacterial counts (TBL), isolated bacteria were identified by MALDI-TOF-MS. If unsuccessful, PCR and 16S rDNA sequencing were performed.

Results

In both treatment groups, TBL decreased immediately after treatment remaining at a lower level. This confirms the findings of the larger study regarding clinical parameters showing a comparable effect on PD, BOP and CAL. Immediately after treatment, the diversity of detected species decreased significantly more than in the sonic group (p = 0.03). After 3 months, the proportion of Gram-positive anaerobic rods was lower in the air-polishing group (powder/ sonic 7%/ 25.9%, p = 0.025). Also, there was a greater reduction of Gram-negative aerobic rods for this group at this time (air-polishing/ sonic − 0.91 / -0.23 Log10 cfu/ ml, p = 0.020).

Conclusion

Within the limitations of this study air-polishing and sonic treatment seem to have a comparable effect on the subgingival oral biofilm during supportive periodontal treatment.

Trial registration

The study was registered in an international trial register (German Clinical Trial Register number DRKS 00006296) on 10th of June 2015. HTML&TRIAL_ID = DRKS00006296.

Effect of air-polishing on surface roughness of composite dental restorative material - comparison of three different air-polishing powders

Background

Increased composite roughness enhances bacterial adhesion and discoloration, thus increasing the risk of gingival inflammation and secondary caries. Concerns about detrimental effects of sodium bicarbonate on surface roughness influenced the development of less abrasive powders: a glycine-based powder and an erythritol-based powder, additionally - sodium bicarbonate-based powder of reduced grain size. However, there is limited evidence on effects of these materials on the surface of dental fillings. The aim of the present study was to compare the effects of three air-polishing powders (of a reduced abrasiveness) on surface roughness of microhybrid restorative composite material.

Material and methods

Microhybrid light-cure resin composite samples were placed on 64 plaster cubes and light-cured through polyester strips. Surface roughness was measured using laser confocal microscope (magnification 2160x). The specimens were randomly divided into three groups (n = 20, 20 and 24) and air-polished with: sodium bicarbonate (40 μm), glycine (25 μm) and erythritol (14 μm), respectively. Then surface roughness was remeasured, keeping the same field of observation. Specialized 3D analysis software was used for data processing. Parameters according to ISO 25178: Sa, Sq, Sku, Sp, Sv, Sz, Ssk were used to describe surface roughness.

Results

Sa, Sq, Sp, Sv, Sz increased significantly following air polishing. Ssk was significantly higher, whereas Sku was significantly lower in sodium bicarbonate and erythritol groups than before air polishing. Comparison between the three powders revealed that Sa was significantly higher in sodium bicarbonate group than in glycine group. Sku was significantly higher in glycine and erythritol groups than in sodium bicarbonate group.

Conclusions

Sodium bicarbonate has a stronger detrimental effect on composite surface than glycine or erythritol. No advantage of erythritol comparing to glycine could be found.

Potential Causes of Titanium Particle and Ion Release in Implant Dentistry: A Systematic Review

Implant surface characteristics, as well as physical and mechanical properties, are responsible for the positive interaction between the dental implant, the bone and the surrounding soft tissues. Unfortunately, the dental implant surface does not remain unaltered and changes over time during the life of the implant. If changes occur at the implant surface, mucositis and peri-implantitis processes could be initiated; implant osseointegration might be disrupted and bone resorption phenomena (osteolysis) may lead to implant loss. This systematic review compiled the information related to the potential sources of titanium particle and ions in implant dentistry. Research questions were structured in the Population, Intervention, Comparison, Outcome (PICO) framework. PICO questionnaires were developed and an exhaustive search was performed for all the relevant studies published between 1980 and 2018 involving titanium particles and ions related to implant dentistry procedures. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the selection and inclusion of the manuscripts in this review. Titanium particle and ions are released during the implant bed preparation, during the implant insertion and during the implant decontamination. In addition, the implant surfaces and restorations are exposed to the saliva, bacteria and chemicals that can potentially dissolve the titanium oxide layer and, therefore, corrosion cycles can be initiated. Mechanical factors, the micro-gap and fluorides can also influence the proportion of metal particles and ions released from implants and restorations.

Clinical and microbiological effects of the supplementary use of an erythritol powder air-polishing device in non-surgical periodontal therapy: a randomized clinical trial

Purpose

This study was undertaken to evaluate the clinical and microbiological effects of an erythritol powder air-polishing device (EPAP) as a supplement to scaling and root planing (SRP) therapy in patients with moderate chronic periodontitis.

Methods

Clinical and microbiological evaluations were performed at 21 sites treated with SRP (control) and 21 sites treated with SRP+EPAP (test). All examinations were performed before treatment, 1 month after treatment, and 3 months after treatment.

Results

There were no significant clinical differences between the test group and the control group. Microbiological analysis revealed that the relative expression level of Porphyromonas gingivalis was significantly lower in the test group than in the control group at 1 month after treatment. Clinical and microbiological results showed improvements at 1 month compared to baseline; in contrast, the results at 3 months after treatment were worse than those at 1 month after treatment.

Conclusions

In this study, both SRP and SRP+EPAP were clinically and microbiologically effective as non-surgical periodontal treatments. In particular, the SRP+EPAP group showed an antimicrobial effect on P. gingivalis, a keystone bacterium associated with the onset of chronic periodontitis, in a short-term period. Periodic periodontal therapy, at intervals of at least every 3 months, is important for sustaining the microbiological effects of this treatment.

The effect of supragingival glycine air polishing on periodontitis during maintenance therapy: a randomized controlled trial

Background

Glycine air polishing has been proved to be safe, comfortable and time-saving. Whether it could substitute ultrasonic scaling to remove dental plaque biofilm during periodontal maintenance remains unclear. The purposes of this study were to evaluate the effect of supragingival glycine air polishing (SGAP) on the subgingival periodontal pathogens during maintenance therapy and to check the association of periodontal pathogens and clinical parameters.

Methods

Twenty-three chronic periodontitis patients during their maintenance therapy were enrolled in the 12-week study. According to randomized split-mouth design, the test side was treated with SGAP (65 μm), while the control side was treated with supragingival ultrasonic scaling and polishing (SUSP) with rubber cup. Clinical examination including plaque index (PLI), probing depth (PD), bleeding index (BI) were performed at baseline and 12 weeks post-treatment. Sampling of the subgingival plaque at each investigational site (mesiobuccal site of the mandibular first molar) was performed at baseline and 2, 4, 8, 12 weeks after maintenance treatment. Four periodontal pathogens including Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Fusobacterium nucleatum were detected by 16S rDNA polymerase chain reaction.

Results

Clinical status generally improved after treatment in both groups. PLI in both groups, PD in SGAP group and bleeding on probing (%) in SUSP group significantly decreased after treatment (p < 0.05). There was no significant difference of clinical parameters between two groups before and after treatment. The detection rates of P. gingivalis, T. denticola in both groups, T. forsythia in SUSP group and F. nucleatum in SGAP group decreased after maintenance treatment in both groups, although no significant difference was found, and it rebound to baseline level at 12 weeks after maintenance treatment. There was no significant difference between SGAP group and SUSP group at any time point. T. denticola-positive sites had significantly greater BI than T. denticola-negative sites (p < 0.05).

Discussion

Supragingival glycine air polishing had a reliable effect in removing subgingival dental plaque biofilm during maintenance period, and three months may be a proper maintenance interval for pockets not more than 5 mm.

Comparison of two different techniques used for the maintenance of peri-implant soft tissue health: a pilot randomized clinical trial

OBJECTIVES

The aim of this pilot study was to compare the effectiveness of two different methods of debridement on maintaining and improving peri-implant soft tissue health over a period of 12 months.

MATERIALS AND METHODS

Twenty adult patients (25 implants) were enrolled in a randomized, single-blinded, parallel group clinical trial. All implants included showed no signs of pathologic bone loss. Patients were scheduled to be reviewed every 3 months over a 12 months period. Nine patients (15 implants) were randomly allocated to a test group and treated with a low abrasive air polishing powder (Air-Flow^® Perio, EMS) (AFP) and another nine (10 implants) to a control group and treated with titanium curettes (TC). Peri-implant crevicular fluid samples were analyzed to quantitatively measure the concentration of six interleukins (IL-6, IL-8, IL-1β, TNF, IL-10 and IL-12). A multilevel analysis was used to test the comparison between the two treatments. The same analysis was used to study the relationship between clinical parameters and cytokines while controlling for confounding factors.

RESULTS

There was no significant difference in bleeding on probing (BOP) between the two treatment methods (p = .35). Both debridement techniques resulted in a similar reduction of BOP (40.04% and 39.93%). IL-6 was the only cytokine of the six investigated that demonstrated a correlation with a clinical parameter (BOP) (p = .05).

CONCLUSIONS

Both treatment methods were proven to be effective in reducing peri-implant inflammation and preventing further disease progression. Some cytokines may act as markers for peri-implant disease as the present study showed a significant relationship between IL-6 and BOP.

Parameters That Improve Cleaning Efficiency of Subgingival Air Polishing on Titanium Implant Surfaces: An In Vitro Study

BACKGROUND

This study aims to reveal how air polishing behaves on a titanium surface by evaluating the size and shape of the cleaned area and the influence of different device settings, probing depths, and cleaning movements.

METHODS

Forty-eight titanium sandblasted large-grit acid-etched surface film-coated disks were treated with an air abrasive system using a subgingival plastic nozzle. Two subgingival models were used: open-ended (step 1) and defined-size (step 2). In step 1, the most effective parameters were investigated by 5-second static applications under different settings. In step 2, the best settings were used for dynamic application to test influence of different movements (up-down, slowly up, rotation). For both steps, powder and water consumption and total cleaned area were calculated.

RESULTS

Air pressure was the main factor with the strongest effect on cleaning. Increasing air pressure extended cleaning area. Other factors, such as nozzle depth and excessive powder flow amount, had weak influence. Cleaning effect reached deeper than the nozzle physically reached. Step 2 showed that there was no significant difference between different nozzle movements; however, cleaning efficiency decreased significantly without movement.

CONCLUSIONS

For the most effective clinical use of air polishing, it should be applied with high pressure, deep insertion of nozzle, and enough water flow. Additionally, the nozzle has to be moved to get the best cleaning effect.

Effects of air polishing and an amino acid buffered hypochlorite solution to dentin surfaces and periodontal ligament cell survival, attachment, and spreading

OBJECTIVES

The aim of this study is to examine morphological changes of dentin surfaces following air polishing or amino acid buffered hypochlorite solution application and to assess their influence on periodontal ligament (PDL) cell survival, attachment, and spreading to dentin discs in vitro.

MATERIALS AND METHODS

Bovine dentin discs were treated with either (i) Classic, (ii) Plus, or (iii) Perio powder (EMS). Furthermore, Perisolv® a hypochlorite solution buffered with various amino acids was investigated. Untreated dentin discs served as controls. Morphological changes to dentin discs were assessed using scanning electron microscopy (SEM). Human PDL cells were seeded onto the respectively treated discs, and samples were then investigated for PDL cell survival, attachment, and spreading using a live/dead assay, adhesion assay, and SEM imaging, respectively.

RESULTS

Both control and Perisolv®-rinsed dentin discs demonstrated smooth surfaces at low and high magnifications. The Classic powders demonstrated the thickest coating followed by the Powder Plus. The Perio powder demonstrated marked alterations of dentin discs by revealing the potential to open dentinal tubules even before rinsing. Seeding of PDL cells demonstrated an almost 100 % survival rate on all samples demonstrating very high biocompatibility for all materials. Significantly higher PDL cell numbers were observed on samples treated with the Perio powder and the Perisolv® solution (approximately 40 % more cells; p < 0.05). SEM imaging revealed the potential for PDL cells to attach and spread on all surfaces.

CONCLUSION

The results from the present study demonstrate that cell survival and spreading of PDL cells on root surfaces is possible following either air polishing or application with Perisolv®. Future in vitro and animal testing is necessary to further characterize the beneficial effects of either system in a clinical setting.

CLINICAL RELEVANCE

The use of air polishing or application with Perisolv amino acid buffered hypochlorite solution was effective in treating root surfaces and allowed for near 100 % PDL cell survival, attachment, and spreading onto all root surfaces.

The effect of air-abrasion on the susceptibility of sound enamel to acid challenge

OBJECTIVE

To evaluate the effect of air-abrasion using three abrasive powders, on the susceptibility of sound enamel to an acid challenge.

METHODS

40 human enamel samples were flattened, polished and assigned to 4 experimental groups (n=10); a: alumina air-abrasion, b: sodium bicarbonate air-abrasion, c: bioactive glass (BAG) air-abrasion and d: no surface treatment (control). White light confocal profilometry was used to measure the step height enamel loss of the abraded area within each sample at three stages; after sample preparation (baseline), after air-abrasion and finally after exposing the samples to pH-cycling for 10 days. Data was analysed statistically using one-way ANOVA with Tukey's HSD post-hoc tests (p<0.05). Unique prismatic structures generated by abrasion and subsequent pH cycling were imaged using multiphoton excitation microscopy, exploiting strong autofluorescence properties of the enamel without labelling. Z-stacks of treated and equivalent control surfaces were used to generate non-destructively 3-dimensional surface profiles similar to those produced by scanning electron microscopy.

RESULTS

There was no significant difference in the step height enamel loss after initial surface air-abrasion compared to the negative control group. However, a significant increase in the step height enamel loss was observed in the alumina air-abraded samples after pH-cycling compared to the negative control (p<0.05). Sodium bicarbonate as well as BAG air-abrasion exhibited similar enamel surface loss to that detected in the negative control group (p>0.05). Surface profile examination revealed a deposition effect across sodium bicarbonate and BAG-abraded groups.

CONCLUSION

This study demonstrates the importance of powder selection when using air abrasion technology in clinical dentistry. Pre-treating the enamel surface with alumina air-abrasion significantly increased its susceptibility to acid challenge. Therefore, when using alumina air-abrasion clinically, clinicians must be aware that abrading sound enamel excessively renders that surface more susceptible to the effects of acid erosion. BAG and sodium bicarbonate powders were less invasive when compared to the alumina powder, supporting their use for controlled surface stain removal from enamel where indicated clinically.

Effect of Air-Polishing on Titanium Surfaces, Biofilm Removal, and Biocompatibility: A Pilot Study

Purpose. The aims of this in vitro study were to evaluate morphological changes induced by glycine powder air-polishing on titanium surfaces, biofilm removal, and biocompatibility. Material and Methods. Titanium grade IV discs were allocated into two groups: (1) discs without biofilm and (2) discs for Streptococcus mutans biofilm formation. Discs in each group were further subdivided into (a) no treatment and (b) air-polishing treatment with glycine powder. Discs were characterized by scanning electron microscopy (SEM), electron-dispersive spectroscopy (EDS), and confocal microscopy. Bacterial biofilms were quantified using a crystal violet dye-binding assay. Biocompatibility was evaluated by measuring the coverage and viability of L929 fibroblast cells cultured on the discs. Results. Air-polishing increased the roughness of treated discs (P < 0.05). EDS analysis did not show significant differences in the chemical composition of treated and nontreated discs. The amount of residual biofilm on treated discs was 8.6-fold lower than untreated controls (P < 0.05). Coverage of treated discs by fibroblasts was half that of untreated discs (P < 0.05) although both groups had the same cell viability. Conclusions. Air-polishing removed a significant amount of biofilm from titanium surfaces. The “polishing” was accompanied by increased surface roughness, but there were no changes in chemical and elemental compositions, nor the biocompatibility.

Health, Maintenance, and Recovery of Soft Tissues around Implants

BACKGROUND

The health of peri-implant soft tissues is one of the most important aspects of osseointegration necessary for the long-term survival of dental implants.

PURPOSE

To review the process of soft tissue healing around osseointegrated implants and discuss the maintenance requirements as well as the possible short-comings of peri-implant soft tissue integration.

MATERIALS AND METHODS

Literature search on the process involved in osseointegration, soft tissue healing and currently available treatment modalities was performed and a brief description of each process was provided.

RESULTS

The peri-implant interface has been shown to be less effective than natural teeth in resisting bacterial invasion because gingival fiber alignment and reduced vascular supply make it more vulnerable to subsequent peri-implant disease and future bone loss around implants. And we summarized common procedures which have been shown to be effective in preventing peri-implantitis disease progression as well as clinical techniques utilized to regenerate soft tissues with bone loss in advanced cases of peri-implantitis.

CONCLUSION

Due to the difference between peri-implant interface and natural teeth, clinicians and patients should pay more attention in the maintenance and recovery of soft tissues around implants.

Efficacy of glycine powder air polishing in comparison with sodium bicarbonate air polishing and ultrasonic scaling - a double-blind clinico-histopathologic study

BACKGROUND

Subgingival biofilm removal using glycine powder air polishing (GPAP) has antecedently been shown to be safe. The hypothesis that GPAP is efficacious during periodontal maintenance therapy and results in less gingival erosion than sodium bicarbonate air polishing (SBAP) or ultrasonic scaling was assessed.

METHODS

Initial periodontal therapy was performed in each of the 22 chronic periodontitis patients having residual 5 mm probing depth in each quadrant and were randomly assigned to one of the following interventions: GPAP (test), SBAP (positive control), ultrasonic scaling (positive control) or no treatment. Clinical parameters were assessed, and gingival biopsies were taken immediately after instrumentation and sent for histological quantification.

RESULTS

Significant improvement in plaque and gingival index scores were noted in glycine powder air-polishing and ultrasonic group. GPAP resulted in minor erosion of the gingival epithelium (score 1 & 2), whereas positive control specimens displayed moderate to severe erosions (score 3 & 4). Difference between GPAP and positive control was significant. (P < 0.05).

CONCLUSION

GPAP results in clinically significant improvement in plaque and gingival index scores and histologically causes less gingival erosion than SBAP or ultrasonic instrumentation, further supporting the safety of this debridement technique in periodontal maintenance therapy.

Pilot study on the clinical and microbiological effect of subgingival glycine powder air polishing using a cannula-like jet

OBJECTIVES

To assess the efficacy of subgingival glycine powder air polishing (GPAP) during supportive periodontal therapy (SPT).

METHODS

Each quadrant of 25 subjects was randomly assigned to the following treatments: subgingival scaling with hand instruments (SRP), GPAP, subgingival ultrasonic debridement (UD) and no subgingival treatment (NT). Clinical recordings included the following: probing pocket depth (PPD), gingival recession (RE), clinical attachment level (CAL), Gingival and Plaque Index. Subgingival plaque samples were taken from two sites >4 mm per quadrant. Therapy, recordings and microbial sampling were performed at baseline, 3 and 6 months, while at 1 month only clinical recordings and sampling were performed. Subgingival samples were analysed using 'checkerboard' DNA-DNA hybridization for Porphyromonas gingivalis, Tannerrella forsythia and Treponema denticola.

RESULTS

All groups were homogeneous at baseline for the clinical parameters assessed. The GPAP group displayed statistically significant higher PPD compared to SRP and UD at 1, 3 and 6 months and no statistical differences with the 'no treatment' group at all time points. At 1 month, the GPAP group displayed statistically significantly higher levels of CAL compared to SRP, while at 3 and 6 months statistically significant differences were observed with groups assigned to SRP and UD. No differences were observed among groups for RE, PI, GI and numbers of the investigated bacteria at any time point.

CONCLUSIONS

On the basis of clinical and microbiological data, this study does not support the superiority of GPAP as sole treatment over SRP or subgingival ultrasonic scaling.