Background: The purpose of this study is to evaluate the safety, patient acceptance, and short-term microbiologic effect of a new air-polishing device in subjects in maintenance care with residual pockets ‡5 mm. Methods: This was an examiner-masked, randomized, split-mouth clinical trial. A new disposable nozzle, allowing the subgingival application of amino acid glycine powder at a limited pressure, was compared to scaling and root planing (SRP) in 50 subjects with residual pockets during the maintenance phase. After removing supragingival deposits, the spray was applied for 4 to 5 seconds in all sites ‡5 mm in the test quadrant, whereas SRP was used in the control quadrant. Microbiologic samples were taken from one treated test and one control site 2 days before and 7 days after treatment. Total bacterial counts and the counts of six periodontal pathogens were determined by real-time polymerase chain reaction. Results: No adverse event was noted in any subject for the test or control treatment. Using a visual analog scale, the patients perceived the test treatment to be significantly less painful/uncomfortable than the hand instrumentation (P <0.001). Significantly less time was used by the operator for the test procedure (P <0.001). The reduction in bleeding on probing was significant for the treated sites in the test and control quadrants (P = 0.019 and P <0.001, respectively), but traditional SRP reduced the bleeding tendency significantly more than air polishing (P = 0.045). The differences in the total bacterial load and the counts of six periodontal pathogens between the test and control sites did not reach statistical significance. The longitudinal reduction was significant in control sites for total bacteria load (P <0.001), Porphyromonas gingivalis (P = 0.01), Treponema denticola (P <0.001), andTannerellaforsythia (previouslyT.forsythensis )( P <0.001). Conclusion: Subgingival air polishing with a new device was safe (no adverse events were noted), perceived to be more acceptable by the patients, and was more time-efficient than SRP; however, on a microbiologic level, it was not superior to conventional SRP. J Periodontol 2010;81:79-88.

Subgingival Plaque Removal Using a New Air‐Polishing Device

Periodontitis is a chronic bacterial infectious disease. Its treatment necessitates thorough removal of the bacterial biofilm during the initial therapy and the periodontal maintenance phase (62, 88, 100). However, debridement using hand instruments or oscillating scalers is both technically demanding and time consuming, and may lead to severe root damage over time (29–31, 52, 98, 101). Even if instrumentation during periodontal maintenance therapy is performed by well-trained and experienced therapists, many patients find debridement uncomfortable, which may have a negative effect on patient compliance (6, 20). Also, safety, as well as ease of biofilm removal, are of major importance because the demand for periodontal therapy is increasing and the number of welltrained dental personnel is limited (12, 42, 68). For optimal treatment of periodontal disease, instrumentation techniques should be employed that can be safely used by the dentist, hygienist or auxiliary dental staff. The use of commercially available injection abrasive water jets, also known as air-polishing devices, allows highly efficient and convenient biofilm removal. With the goal of establishing an efficient and safe technique for subgingival biofilm removal, a low-abrasive air-polishing powder (Clinpro Prophypowder; 3M ESPE, Seefeld, Germany) was developed for use in commercially available air-polishing devices (26, 27, 77). This novel approach to biofilm removal substantially facilitates periodontal debridement. The purpose of this article was to review the safety and efficacy of the application of glycine powder air-polishing in the treatment of oral biofilm infections. Air-polishing devices: basic function principles

Subgingival air-polishing in the treatment of periodontal biofilm infections.

Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.

Low‐cost periodontal therapy

Objectives: Safety and efficacy of glycine powder air-polishing (GPAP) in removing subgingival biofilm have been previously demonstrated. The hypothesis that GPAP results in less gingival erosion than sodium bicarbonate air-polishing (SBAP) or hand-instrumentation was assessed.

Material and Methods: In each of 10 patients, eight teeth with a residual probing depth of at least 5 mm following initial periodontal therapy were randomly assigned to the following interventions: GPAP (test), SBAP (positive control), hand-instrumentation (positive control), or no treatment (negative control). In each group, gingival biopsies were taken immediately after instrumentation and one 14 days later. Damaged gingival epithelium (GE) was assessed by light microscopy and quantified by a histological score (values 1–4). Differences between groups were evaluated using the marginal homogeneity test.

Results: GPAP resulted in minor erosions of the GE (scores 1 and 2), whereas positive control specimens displayed moderate to severe erosions (scores 2–4). Differences between GPAP and positive controls were significant (p<0.05). Fourteen days following instrumentation GE under assessment was found to be intact in all groups.

Conclusion: The data indicated that GPAP results in less gingival erosion than SBAP or hand instrumentation, further supporting the safety of this new debridement technique.

Effect of glycine powder air‐polishing on the gingiva

Wennstrom JL, Dahlen G, Ramberg P. Subgingival debridement of periodontal pockets by air polishing in comparison to ultrasonic instrumentation during maintenance therapy. J Clin Peridontol 2011; 38: 820–827. doi: 10.1111/j.1600-051X.2011.01751.x.

Abstract
Aim: The objective was to determine clinical and microbiological effects and perceived treatment discomfort of root debridement by subgingival air polishing compared with ultrasonic instrumentation during supportive periodontal therapy (SPT).

Material and methods: The trial was conducted as a split-mouth designed study of 2-month duration including 20 recall patients previously treated for chronic periodontitis. Sites with probing pocket depth (PPD) of 5–8 mm and bleeding on probing (BoP+) in two quadrants were randomly assigned to subgingival debridement by (i) glycine powder/air polishing applied with a specially designed nozzle or (ii) ultrasonic instrumentation. Clinical variables were recorded at baseline, 14 and 60 days post-treatment. Primary clinical efficacy variable was PPD reduction. Microbiological analysis of subgingival samples was performed immediately before and after debridement, 2 and 14 days post-treatment.

Results: Both treatment procedures resulted in significant reductions of periodontitis-associated bacterial species immediately and 2 days after treatment, and in significant reduction in BoP, PPD and relative attachment level at 2 months. There were no statistically significant differences between the treatment procedures at any of the examinations intervals. Perceived treatment discomfort was lower for air polishing than ultrasonic debridement.

Conclusion: This short-term study revealed no pertinent differences in clinical or microbiological outcomes between subgingival air polishing and ultrasonic debridement of moderate deep pockets in SPT patients.

Subgingival debridement of periodontal pockets by air polishing in comparison with ultrasonic instrumentation during maintenance therapy

Background: Glycine powder air polishing (GPAP) has been shown to be significantly more effective in reducing the subgingival cultivable microflora in shallow periodontal pockets compared to curets and is safe when applied directly to root surfaces. The purpose of this study was to assess the subgingival debridement efficacy of GPAP in periodontal pockets with various depths. Methods: In each of 60 patients with severe periodontitis, one tooth with a probing depth (PD) ≥6 mm was randomly assigned to one of the following interventions: GPAP performed in teeth instrumented 3 months earlier (I); GPAP performed in previously non-instrumented teeth (NI); or no treatment (control). GPAP was performed for 5 seconds per surface. After extraction, teeth were stained with 0.5% toluidine blue, and subgingival debridement efficacy was assessed. Results: Overall, median debridement depth was 2.00 mm in I teeth and 1.86 mm in NI teeth, and the median debrided root surface was 49.24% and 45.64%, respectively. In anatomic PDs (APDs) of 2 to 3 mm, relative debridement depth (debridement depth/APD) ranged from 65% to 80% and 60% to 75% in I and NI teeth, respectively; the corresponding values for debrided root surface were 60% to 70% and 50% to 60%. In control teeth, virtually all subgingival root surfaces were stained. Clinical PD measurements were a median of 1.05 mm deeper than APD. Conclusion: GPAP for 5 seconds per surface is effective in removing most of the subgingival biofilm in periodontal pockets with an APD ≤3 mm.

Subgingival Debridement Efficacy of Glycine Powder Air Polishing

The invention relates to a method for analysis and to a device for carrying out the method. The method comprises the following steps: a) removing an applicator from a device comprising a pocket for receiving an applicator and at least one first compartment for receiving an indicator substance, said compartment having means for being connected to the pocket in the form of a connecting area to be opened selectively; b) wetting the applicator with a substance, for example saliva; c) introducing the applicator into the device; d) activating the device by exerting pressure on a compartment or by inserting the applicator into the compartment.

Method for carrying out a saliva analysis

The present invention relates to a dental composition comprising an aqueous Solution of 1 ) at least one acidic Compound, 2) at least one salt of said acidic Compound, 3) at least one indicator that generates a detectable Signal when said Solution reaches a particular pH value that is less than 5.5 wherein 1 ) and 2) are selected such that the aqueous Solution has a pH of less than that particular pH value where the indicator generates the Signal. It further relates to a method for detection of carious tissue on the surface of a tooth, comprising the Steps of 1 ) providing the above mentioned dental composition, 2) applying said composition to the surface of said tooth, and 3) measuring the amount of time required for the composition to change color. It further relates to the use of said dental composition to manufacture a remedy for detection of carious tissue.

Dental composition for detection of carious tissue, detection method

The invention relates to dental material containing at least one substance, whose bacteriostatic and/or bactericidal activity develops in the presence of intra-oral micro-organisms. The invention also relates to the use of a substance, whose bacteriostatic and/or bactericidal activity develops in the presence of intra-oral micro-organisms, for producing dental material.

Ingo Haeberlein

Papers

Effect of glycine powder air‐polishing on the gingiva

Subgingival Debridement Efficacy of Glycine Powder Air Polishing

Method for carrying out a saliva analysis

Dental composition for detection of carious tissue, detection method

Dental material containing bacteriostatic and/or bactericidal substances