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

Abstract

AimGlycine 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 MethodsOver 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.ResultsThe 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.ConclusionsIn 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.

Results of an experimental study of subgingival cleaning effectiveness in the furcation area

“…With low-abrasiveness powders, AP devices combine minimal abrasion with a maximal cleaning effect [ 32 , 34 , 35 ]. Nevertheless, they largely performed worse than SC in molars with FI in our experimental study, which corroborated the clinical findings of a study by Petersilka et al [ 11 ]. Only with the subgingival nozzle did LAPA-1 show an approximately similar cleaning performance to US (Tables 1 , 2 ); however, LAPA-1 had a nearly 1.4-fold shorter TrT (Table 3 , p < 0.001).…”

“…Accordingly, several visits for SPT are necessary in a patient’s lifetime to prevent further periodontal inflammation, and professional mechanical biofilm removal should be performed with special attention to teeth with exposed root surfaces or residual pockets [ 9 ]. The use of a hand or powered scaler (SC) to remove mineralized and nonmineralized biofilms is the most widely accepted method of conventional mechanical debridement [ 10 , 11 ], while air polishing (AP) is preferred for nonmineralized biofilms [ 12 ]. In particular, low-abrasiveness powder air polishing (LAPA) is recognized as a minimally invasive tool for the management of biofilms colonizing tooth and root surfaces [ 12 ], as effective biofilm removal can be achieved while preserving the integrity of the root surface and soft tissue [ 13 ].…”

“…In particular, low-abrasiveness powder air polishing (LAPA) is recognized as a minimally invasive tool for the management of biofilms colonizing tooth and root surfaces [ 12 ], as effective biofilm removal can be achieved while preserving the integrity of the root surface and soft tissue [ 13 ]. Different low-abrasiveness powders, e.g., glycine and erythritol, have been demonstrated to provide a fast and reliable method for removing subgingival biofilms, requiring a high level of comfort for both the patient and the operator [ 11 , 14 ]. Petersilka et al [ 11 ] found that LAPA with glycine was equivalent to solely subgingival regarding the number of sites with stable pocket probing depths (PPDs) and the biofilm index in long-term SPT.…”

“…Different low-abrasiveness powders, e.g., glycine and erythritol, have been demonstrated to provide a fast and reliable method for removing subgingival biofilms, requiring a high level of comfort for both the patient and the operator [ 11 , 14 ]. Petersilka et al [ 11 ] found that LAPA with glycine was equivalent to solely subgingival regarding the number of sites with stable pocket probing depths (PPDs) and the biofilm index in long-term SPT. However, for molars with furcation involvement (FI), the authors noted that these root sites were not as treatable as other sites and recommended SC.…”

“…However, for molars with furcation involvement (FI), the authors noted that these root sites were not as treatable as other sites and recommended SC. Furthermore, they noted a trend toward deterioration of the FI status in the LAPA group and indicated the use of conventional “showerhead”-like air polishing nozzles in molar furcations as a possible reason [ 11 ]. Another recent study by Ulvik et al [ 15 ] investigated the clinical parameters of erythritol air polishing versus curette/ultrasonic cleaning in the treatment of mandibular molars with grade II furcation, revealing that, despite the use of a special nozzle for air polishing, there was a significant difference in clinical attachment level in favor of hand or powered instruments after 6 months.…”