Air polishing

The air polishing is a process for the removal of soft plaque (biofilm / plaque) and stains on natural teeth and implants . In practice, terms such as air flow, powder jet cleaning or air-powder-water jet technology (LPW) are used synonymously. Air polishing with water must be differentiated from conventional air abrasion without the addition of water. The procedure must be carried out with a suitable powder. It is not suitable for removing tartar.

application

In dental practices, air polishing can be used as part of professional tooth cleaning (PZR). The procedure is mainly carried out on the patient by prophylactic staff, therefore by

Areas of application

Air polishing is used for the supragingival (above the gum line) and subgingival (below the gum line) removal of plaque and discoloration, as well as the treatment of patients with peri-implantitis and periodontitis . Air-polishing is also used in preparation for tooth whitening (bleaching).

history

In 1945 Robert Black developed the first device called Air Dent for use in cavity preparation and prophylaxis . It contained a highly abrasive sodium bicarbonate powder. An air-powder mixture for polishing teeth was first presented in 1976. The mixture was passed through a nozzle in a handpiece and aimed at the tooth surface to remove stain and plaque. Air-polishing was criticized for being particularly abrasive and thus damaging the tooth enamel or the root cement and being painful for the patient.

Due to the development of very finely ground powders based on erythritol and glycine in the 1970s, the abrasive effect of which is greatly reduced, air polishing is now safely used on hard and soft tissue as well as filling material, implants and other dentures. The removal of hard tooth substance is hardly measurable and the gums are not irritated by the use of glycine powder. In 1981 Dentsply launched the Cavitron Prophy-Jet as the first air polishing device .

functionality

Functional diagram of an air-polishing device

A mixture of fine powder particles, water and air is sprayed under controlled pressure via a nozzle onto the surface of the natural tooth or implant to be cleaned. The powder / water particles hit the area to be cleaned in the form of a fine jet at high speed. Adhering plaque and discoloration are removed by the kinetic energy of the particles. Depending on the treatment area and the severity of the deposits, different types of powder with different powder properties such as particle sizes and shapes are used. The jet is heated beforehand because the speed of the air flow causes the mixture to hit the tooth very cold, which can be painful.

The spraying range of the powder water jet depends on the one hand on the composition of the nozzle and on the other hand on the fine grain of the powder. The finer the powder, the more even and focused the spray jet and the cleaning.

Influential factors on the cleaning result

Air-polishing device

Air-polishing powders have different grain sizes and shapes. This means that their abrasion and cleaning effect is dosed weaker or stronger. With the same powder base and very similar ingredients, the effect on the treated surface can vary greatly from manufacturer to manufacturer. A distinction is made between water-soluble powders (erythritol, glycine and sodium bicarbonate) and water-insoluble powders ( calcium carbonate , aluminum trihydroxide, bioactive glass).

According to current studies, glycine-based powders remove soft plaque (biofilm / plaque) more thoroughly than traditional hand instruments. In addition, they protect the gums and the hard tooth substance, so that their use is also recommended for the treatment of periodontal patients.

Erythritol (sugar alcohol) as a powder base enables a grain size of 14 µm and even gentler cleaning. Erythritol powder combined with a germicidal component such as chlorhexidine can not only remove the biofilm mechanically, but also reduce it chemically. This is more effective than glycine-based powder. Further studies comparing the effectiveness of erythritol to the effectiveness of glycine are currently being conducted.

Air-polishing with a rather coarse-grained powder based on sodium bicarbonate (grain size approx. 70 µm) has a strong abrasive effect on dentin and dental cement. It also irritates the gums. Only a slight abrasive effect was found on tooth enamel. Sodium bicarbonate-based powder is therefore recommended for supragingival air polishing as part of normal professional tooth cleaning . It is rather unsuitable for periodontitis and peri-implantitis patients.

Other influencing factors are:

Duration of use
Distance of the nozzle to the surface
Type of surface: dental cement, dentine , enamel, filling material, implant, etc.
Use above and / or below the gum line
Thickness of the deposits and discoloration
Application angle of the beam
Consistency of the powder: This has an effect on the flow properties of the powder.
Air-polishing instruments: device, handpiece, nozzle

advantages

In contrast to cleaning with hand instruments , studies show that when the air polishing process is used correctly, plaque can be removed more thoroughly while protecting the gums and hard tooth structure.
In the context of periodontal therapy, air polishing with glycine-based powder is more effective than cleaning with hand instruments. Pathogenic germs can be reduced significantly more in the long term.
Patients find cleaning with air polishing more pleasant than with hand instruments. This is also due to the reduced irritation of the gums.
Hard-to-reach places in the mouth , such as the spaces between the teeth, can be cleaned more easily. Therefore, this type of professional tooth cleaning is particularly advantageous for patients with implants, crowns , bridges and fixed orthodontic appliances.
There are no whistling noises as is the case when cleaning with a sonic / ultrasonic scaler.
Considerably shorter treatment times using an air polishing device compared to sonic / ultrasonic scalers and curettes.

restrictions

During the treatment, protective goggles are always recommended for the patient and the practitioner so that no powder grains can get into the eyes.
This type of tooth cleaning should be avoided in patients with bronchial asthma or other breathing difficulties.
An emphysema in the cleaning of gingival pockets is possible. However, this is due to incorrect application of the air-polishing process.
Long-term studies are currently still lacking to validate the superior effectiveness of the air polishing process in the continuous treatment of periodontitis and peri-implantitis patients.
Air polishing is not suitable for removing tartar . For this purpose, magnetostrictive and piezoelectric ultrasonic scalers and compressed air operated sound scalers are used.
In addition, the gums (gingiva) can be damaged.

Manufacturers and Products

Manufacturer	EMS	Acteon	KaVo	LM	Hager & Werken	NSK	3M ESPE
equipment	Air-Flow S1, Air-Flow S2, Air-Flow Master, Air-Flow handy	Air-N-Go, Air-N-Go easy	Prophyflex	LM ProPower	Cavitron Prophy Jet Air Polisher	Prophy-Mate, Perio-Mate
powder
based on erythritol	Air-Flow Plus
based on glycine	Air-Flow Perio, Soft	Air-N-Go Perio	Prophyflex Perio	LM-Glycine			Clinpro Glycine Prophy Powder
based on sodium bicarbonate	Air-Flow Classic, Classic Comfort	Air-N-Go Classic	Prophyflex	LM Sodium B	Cavitron Prophy Jet	Prophy Mate Cleaning Powder
based on calcium carbonate		Air-N-Go Pearl	Prophypearls	LM calcium C		Flash Pearl
based on aluminum trihydroxide					Cavitron Jet-Fresh

Individual evidence

^ Roulet, Jean-Francois / Zimmer, Stefan: Prophylaxis and preventive dentistry. Color atlases of dentistry volume 16. Ed. Rateitschak, Klaus H. / Wolf, Herbert F. Georg Thieme Verlag Stuttgart, 2002. ISBN 3-13-158351-7 .
↑ ^a ^b ^c ^d Bühler J. [u. a.] (2014): A systematic review on the effects of air polishing devices on oral tissues. In: International Journal of Dental Hygiene, 2016, Vol. 14, pp. 15-28.
^ Black, RB, Technic for nonmechanical preparation of cavities and prophylaxis. Journal of the American Dental Association , (1945) Issue 32: pp. 955-965.
↑ Nazia Chopra, Sumit Abrol: Effect Of Air Polishing on Tooth Surface: Comparative Evaluation Of Effect Of Sodium Bicarbonate And Glycine Air Powder On The Surface Topography of the Tooth . Omniscriptum GmbH & Company Kg., 2015, ISBN 978-3-659-75385-5 ( google.com ).
^ ^A ^b ^c ^d ^e ^f ^g ^h ⁱ R. Moëne, F. Décaillet, A. Mombelli: [Subgingival air-polishing: new perspectives for periodontal maintenance?]. In: Swiss monthly for dentistry = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia / SSO. Volume 120, Number 10, 2010, pp. 891-911, PMID 21548319 (review).
↑ Timeline - History of dental hygienists ( Memento of March 14, 2016 in the Internet Archive ), American Dental Hygienists Association (ADHA). Retrieved March 15, 2016.
↑ Barnes, Caren M. [u. a.] (2014): An In Vitro Comparison of the Effects of Various Air Polishing Powders on Enamel and Selected Esthetic Restorative Materials. In: The Journal of Clinical Dentistry. Vol. 4, No. 25, pp. 76-87.
↑ L. Drago, M. Del Fabbro, et al. a .: Biofilm removal and antimicrobial activity of two different air-polishing powders: an in vitro study. In: Journal of periodontology. Volume 85, number 11, November 2014, pp. E363 – e369, doi: 10.1902 / jop.2014.140134 , PMID 25060742 .
↑ Nastri, L. / Miraldi, G. / Ripoli, R .: Treatment of peri-implantitis using an air-polishing device with erythritol powder or mechanical debridement: a randomized, controlled split mouth clinical study. In: Clinical Oral Implants Research, 2014, Vol. 25, No. 10, pp. 645-646.

[1] Roulet, Jean-Francois / Zimmer, Stefan: Prophylaxis and preventive dentistry. Color atlases of dentistry volume 16. Ed. Rateitschak, Klaus H. / Wolf, Herbert F. Georg Thieme Verlag Stuttgart, 2002. ISBN 3-13-158351-7 .

[Studie_2-2] Bühler J. [u. a.] (2014): A systematic review on the effects of air polishing devices on oral tissues. In: International Journal of Dental Hygiene, 2016, Vol. 14, pp. 15-28.

[3] Black, RB, Technic for nonmechanical preparation of cavities and prophylaxis. Journal of the American Dental Association , (1945) Issue 32: pp. 955-965.

[4] Nazia Chopra, Sumit Abrol: Effect Of Air Polishing on Tooth Surface: Comparative Evaluation Of Effect Of Sodium Bicarbonate And Glycine Air Powder On The Surface Topography of the Tooth . Omniscriptum GmbH & Company Kg., 2015, ISBN 978-3-659-75385-5 ( google.com ).

[Studie_3-5] A ^b ^c ^d ^e ^f ^g ^h ⁱ R. Moëne, F. Décaillet, A. Mombelli: [Subgingival air-polishing: new perspectives for periodontal maintenance?]. In: Swiss monthly for dentistry = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia / SSO. Volume 120, Number 10, 2010, pp. 891-911, PMID 21548319 (review).

[6] Timeline - History of dental hygienists ( Memento of March 14, 2016 in the Internet Archive ), American Dental Hygienists Association (ADHA). Retrieved March 15, 2016.

[Studie_4-7] Barnes, Caren M. [u. a.] (2014): An In Vitro Comparison of the Effects of Various Air Polishing Powders on Enamel and Selected Esthetic Restorative Materials. In: The Journal of Clinical Dentistry. Vol. 4, No. 25, pp. 76-87.

[Studie_6-8] L. Drago, M. Del Fabbro, et al. a .: Biofilm removal and antimicrobial activity of two different air-polishing powders: an in vitro study. In: Journal of periodontology. Volume 85, number 11, November 2014, pp. E363 – e369, doi: 10.1902 / jop.2014.140134 , PMID 25060742 .

[Studie_5-9] Nastri, L. / Miraldi, G. / Ripoli, R .: Treatment of peri-implantitis using an air-polishing device with erythritol powder or mechanical debridement: a randomized, controlled split mouth clinical study. In: Clinical Oral Implants Research, 2014, Vol. 25, No. 10, pp. 645-646.