Efficacy of erythritol powder air‐polishing in active and supportive periodontal therapy: A systematic review and meta‐analysis

Abstract

Objective This systematic review aimed to analyse available evidence to answer two focused questions about the efficacy of erythritol powder air‐polishing (EPAP) (i) as an adjunctive during active periodontal therapy (APT) and (ii) as an alternative to hand/ultrasonic instrumentation during supportive periodontal therapy (SPT). Additionally, microbiological outcomes and patient's comfort/perceptions were assessed as secondary outcomes. Methods PubMed, Cochrane and Medline were searched for relevant articles published before February 2021 following PRISMA guidelines. The search was conducted by three independent reviewers, and the agreement was measured by Cohen's kappa score. Out of 1043 articles, eight randomized clinical trials were selected for systematic review and quantitative synthesis. Only periodontal parameters, such as clinical attachment level (CAL), probing pocket depth (PPD) and bleeding on probing (BoP), showed homogeneity and, thus, were selected for meta‐analysis. Results The improvement in PPD and BoP scores after using EPAP was comparable with hand/ultrasonic instrumentation during both APT and SPT. Significant CAL gain was achieved with EPAP during APT (0.16 mm, p < 0.02) compared with hand/ultrasonic instrumentation at the end point, whereas non‐significant CAL gain was achieved during SPT. No differences were observed regarding microbiological outcomes between the two treatment modalities. However, EPAP inflicted less pain and was better perceived by the patients. Conclusion Erythritol powder air‐polishing can substitute hand/ultrasonic instrumentation for SPT, and CAL gain is significantly improved when EPAP is used as an adjunct during APT. For microbiological outcomes, no significant differences were observed between the two approaches; however, EPAP was better tolerated by the patients than hand/ultrasonic instrumentation. Clinical relevance Erythritol powder air‐polishing can be used as an adjunct during APT and as an alternative to conventional mechanical debridement during SPT.

Effectiveness and Clinical Performance of Erythritol Air-Polishing in Non-Surgical Periodontal Therapy: A Systematic Review of Randomized Clinical Trials

“…APT aims to set the parameters for preventing periodontal deterioration and minimization of deep periodontal pockets and implicitly for tooth and periodontal attachment preservation [ 3 ]. The boundaries of APT are defined by the nonappearance of pocket defects deeper than 4 mm, accompanied by bleeding on probing (BOP) or by the nonappearance of probing depths (PD) equal or more than 6 mm [ 4 ].…”

“…When endpoints of APT have been reached, patients must undergo a maintenance phase known as supportive periodontal therapy (SPT) in order to preserve the results obtained during the active periodontal therapy [ 4 ]. SPT is focused on the minimization of reinfection episodes and on preventing the evolution of the pathology, by sustaining patient comfort, without the occurrence of acute symptoms or increased tooth mobility.…”

“…SPT is focused on the minimization of reinfection episodes and on preventing the evolution of the pathology, by sustaining patient comfort, without the occurrence of acute symptoms or increased tooth mobility. The main goal of SPT is to inhibit newly generated supra- and subgingival microbiota as well as recent dental deposits [ 4 ]. Manresa and coworkers underline that SPT should cover all aspects of a standard dental assessment, which includes periodontal reexamination with risk analysis, removal of dental plaque, and if necessary, calculus supra and subgingival reinterventions on sites with unremitting disease [ 5 ].…”

“…Furthermore, sodium bicarbonate powder was shown to have more negative effects on the periodontal cell density and viability when compared to other similar products [ 8 ]. Recently, erythritol powder air-polishing (EPAP) has been introduced in APT and SPT [ 4 ]. The use of this product indicated non-traumatic effects onto periodontal tissues and improved periodontal parameters; some limitations have been reported, such as limitations in removing large deposits of calculus or other deposits [ 4 ].…”

Clinical Trial for Evaluating the Effectiveness and Safety of a New Dental Plaque Removal Device: Microscale Mist Unit

“…However, the application of these devices is limited to the teeth, and there are no reports investigating the effect of these methods on the oral mucosa. Recently, air abrasion devices also became available for plaque removal [ 15 , 16 , 17 , 18 , 19 , 20 ], and it was recognized that their proper use will not result in harmful effects on the oral mucosa [ 21 ]. However, the use of these devices is also limited to the areas around the tooth surface and gums and requires trained skills.…”