Management of periodontal disease is achieved through disruption of microbial biofilm and removal of calculus. This is often done via hand scaling and ultrasonic scalers. However, these techniques can contribute to soft and hard tissue damage as well as patients experiencing sensitivity due to exposure of dentin tubules. Recently, studies have shown air-polishing provides similar results with superior outcomes regarding patient comfort. A systematic review concluded that air-polishing is comparable to conventional periodontal therapies in single and multi-rooted teeth without furcations. A randomized controlled trial published January 2021 in the journal BMC Oral Health aimed to “compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.”1
Study subjects were chosen from patients enrolled in the supportive periodontal therapy (SPT) program during June 2015 through June 2016 at the University of Bergen. Clinical assessment parameters that were recorded at baseline, 3, 6, 9, and 12 months included PD, and CAL using a PCP, UNC 15 periodontal probe. Gingival crevicular fluid was assessed at baseline and at 6- and 12-month intervals. This was achieved using a perio paper strip and the Periotron 8000®. Microbial assessment was conducted at baseline, and at 6- and 12-month intervals. Microbiological assessments were achieved using paper points inserted into the pocket of the furcation site for 20s, immersed in a transport medium and sent to Microbiological Diagnostic Services for analysis. Pain experienced by subjects was assessed using a visual analogue scale, this was done 12-months following debridement. The scale ranged from 0 = “no pain” and 100 = “worst pain I can imagine.”
Using a split-mouth study design, mandibular jaw quadrants were randomized to receive debridement using either erythritol powder/air-polishing or ultrasonic/curette instrumentation. Treatment was completed at baseline, and repeated at 3, 6, 9 and 12-month intervals. Results showed both erythritol air-polishing and mechanical debridement provide clinical improvement. A significant difference in CAL was observed in favor of conventional debridement, while erythritol air-polishing was observed as the “most comfortable intervention by the patients.”
Limitations acknowledged in the study include a small sample size, selection bias (only using mandibular molars), and CONSORT guidelines for randomization were not followed. Additionally, anatomical confounders of different teeth that are more difficult to access was not adjusted for, which could lend to confounding bias.
The authors conclude, “The observations suggest that conventional mechanical debridement and erythritol air-polishing both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favor of conventional debridement at 6 months. Treatments displayed similar effects on the subgingival microflora. The erythritol air-polishing system was deemed the most comfortable intervention by the patient.”
Do you utilize erythritol air-polishing during periodontal maintenance? Considering the observation that erythritol air-polishing is deemed more comfortable for the patient, do you think utilizing it would improve patient compliance? Even with better clinical attachment level using conventional debridement, do you think patient comfort should be a bigger consideration for treatment options?
- Ulvik IM, Sæthre T, Bunæs DF, Lie SA, Enersen M, Leknes KN. A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy. BMC Oral Health. 2021 Jan 21;21(1):38. doi: 10.1186/s12903-021-01397-3. PMID: 33478480; PMCID: PMC7819243.