EMS CLINICAL EVIDENCE } AIR-FLOW PERIO ON NATURAL TEETH AND IMPLANTS SCIENTIFIC LITERATURE IN PERIODONTOLOGY

Transcription

1 EMS CLINICAL EVIDENCE } AIR-FLOW PERIO ON NATURAL TEETH AND IMPLANTS SCIENTIFIC LITERATURE IN PERIODONTOLOGY

2 EMS CLINICAL EVIDENCE } AIR-FLOW PERIO ON NATURAL TEETH AND IMPLANTS SCIENTIFIC LITERATURE IN PERIODONTOLOGY

3 AIR-FLOW INCREASINGLY SIGNIFICANT IN MODERN PROPHYLAXIS EMS Original Method AIR-FLOW Perio Scientific Evidence The objective of successful prophylaxis is to achieve and maintain an apathogenic microbial environment in the patient long-term through oral hygiene measures both at home and by a professional. Not only will this maintain oral health for life, but it will also contribute towards improving health overall. Over 30 years ago Ramfjord 1 was one of the first to point out the paramount importance of biofilm management; he maintained that even in patients with imperfect oral hygiene the results of periodontal therapy could be stabilised over a period of years if they were recalled every three months for professional subgingival and supragingival plaque control. The literature over the subsequent 20 years has confirmed and expanded on this observation by Ramfjord. Periodontology today goes one step further: if the potential of modern, non-surgical periodontal therapy is consistently applied, the need for periodontal surgical intervention will significantly decrease. Modern air-polishing devices (AIR-FLOW ) and their specific powders for subgingival application are becoming increasingly significant in the context of maintenance therapy. However, before they can be introduced into routine everyday practice, science must provide sound evidence of the safety, efficacy and endurance of new methods compared with a variety of other procedures from a clinical as well as ethical viewpoint. The following literature on the use of air-polishing devices (AIR-FLOW ) in periodontology can be summarised as follows: > The indication for the use of air-polishing devices (AIR-FLOW ) was expanded by the development of new glycine-based powders. Thus air-polishing devices (AIR-FLOW ) can also be used subgingivally to remove biofilm in the context of periodontal maintenance therapy as well as to clean implants. > The superiority of air-polishing devices (AIR-FLOW ) compared with other biofilm management methods is shown in clinical as well as microbial parameters. Air-polishing devices (AIR-FLOW ) are efficient, reliable, safe, time-saving and gentle on tissues. Treatment is also associated with greater patient comfort. The clinical study results listed here make persuasive reading. Yours faithfully, Dr. Klaus-Dieter Bastendorf Joint practice 2 of Dr. Bastendorf + Dr. Schmid, Germany 1 Tooth mobility and periodontal therapy Fleszar TJ, Knowles JW, Morrison EC, Burgett FG, Nissle RR, Ramfjord SP Journal of Clinical Periodontology, 1980; 7: For over 30 years Successful prophylaxis has been the recipe of success of the joint practice of Dr. Bastendorf + Dr. Schmid in Eislingen ( Southern Germany ). Today approximately 30 dental professionals work day in-day out in the practice that specialises in prophylaxis, in maintaining healthy natural teeth. To do this, Dr. Bastendorf relies on EMS equipment and accessories and is therefore speaking from personal experience when it comes to the use of EMS air-polishing devices in prophylaxis as a whole ( editorial comments )

4 TABLE OF CONTENT EMS Original Method AIR-FLOW Perio Scientific Evidence } NATURAL TEETH / P Subgingival plaque removal at interdental sites using a low abrasive air-polishing powder J Periodontol / Petersilka GJ, Tunkel J, Barakos K, Heinecke A, Häberlein I, Flemmig TF Subgingival plaque removal in buccal and lingual sites using a novel low abrasive air-polishing powder J Clin Periodontol / Petersilka GJ, Steinmann D, Häberlein I, Heinecke A, Flemmig TF Subgingival debridement efficacy of glycine powder air-polishing J Periodontol / Flemmig TF, Hetzel M, Topoll H, Gerss J, Haeberlein I, Petersilka GJ Effect of glycine powder air-polishing on gingiva J Clin Periodontol / Petersilka GJ, Faggion Jr CM, Stratmann U, Gerss J, Ehmke B, Haeberlein I, Flemmig TF Subgingival plaque removal using a new air-polishing device J Periodontol / Moëne R, Décaillet F, Andersen E, Mombelli A Randomized controlled trial assessing efficacy and safety of glycine powder air-polishing in moderate to deep periodontal pockets J Periodontol. Online 2011 / Flemmig TF, Arushanov D, Daubert D, Rothen M, Mueller G, Leroux BG Subgingival debridement of periodontal pockets by air polishing in comparison with ultrasonic instrumentation during maintenance therapy J Clin Periodontol / Wennström JL, Dahlén G, Ramberg P In vitro analysis of the effects of novel air polishing devices on human teeth preliminary result EUROPERIO 2012 abstract / Bühler J, Schmidli F, Weiger R, Walter C Clinical outcomes following subgingival application of a novel erythritol powder by means of air polishing in supportive periodontal therapy: a randomized, controlled clinical study Quintessence International 2013 / Hägi TT, Hofmänner P, Salvi GE, Ramseier CA, Sculean A Twelve-month evaluation of sub gingival air polishing during maintenance Preliminary results, study publication expected in 2014 / Müller N, Moëne R, Cancela J, Mombelli A A paradigm shift in mechanical biofilm management? Subgingival air polishing: a new way to improve mechanical biofilm management in the dental practice Quintessence International, 2013 / Bastendorf KD, Becker C, Bush B, Einwag J, Lanoway C, Platzer U, Schmage P, Schoeneich B, Walter C, Wennström JL, Flemmig TF, Sculean A 2

5 TABLE OF CONTENT EMS Original Method AIR-FLOW Perio Scientific Evidence } IMPLANTS / P Influence of different air-abrasive powders on cell viability at biologically contaminated titanium dental implants surfaces J Biomed Mater Res 2009 / Schwarz F, Ferrari D, Popovski K, Hartig B, Becker J Non-surgical treatment of periimplantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine: a prospective, randomized, controlled clinical study J Clin Periodontol / Sahm N, Becker J, Santel T, Schwarz F Treatment of periimplantitis using an Er:YAG laser or an air-abrasive device: a randomized clinical trial J Clin Periodontol / Renvert S, Lindahl C, Roos Jansaker AM, Persson GR The effect of glycine-powder AIR-FLOW and hand instrumentation on peri implant soft tissues: a Split mouth Pilot study Int J Prosthodontol 2013 / Mussano F, Rovasio S, Schierano G, Baldi I, Carossa S 3

6 Natural Teeth Subjects 23 AIR-POLISHING v. HAND INSTRUMENTATION Environment Duration in vivo 6 months Subgingival plaque removal at interdental sites using a low abrasive air polishing powder Petersilka GJ, Tunkel J, Barakos K, Heinecke A, Häberlein I, Flemmig TF Journal of Periodontology, 2003 March; 74(3): Aim: To evaluate the efficacy of a new air-polishing powder in subgingival plaque removal at interdental sites during periodontal maintenance therapy Conclusion: In periodontal maintenance therapy, air-polishing with glycine-based powder is more effective than hand INSTRUMENTATION in removing subgingival plaque at INTERDENTAL sites with up to 5 mm probing depth, in ADDITION to being time-efficient and safe 4

7 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 23 subjects with generalized moderate to severe periodontitis and at least one tooth per quadrant with a probing depth of 3 5 mm at interdental sites were selected > Each subject had completed initial periodontal therapy and was receiving supportive periodontal therapy Devices: > Test group: Treatment was performed using an EMS AIR-FLOW S1 and a glycine-based air-polishing powder (Clinpro Prophy Powder, 3M ESPE) at medium water and powder settings > Positive control: Treatment was performed using sterile Gracey curettes Nos 5/6, 7/8, 11/12 and 13/14 Procedure: > Treatment assignment was random, using a split-mouth design > Two quadrants in each patient were assigned to test treatment (subgingival air-polishing with glycinebased powder), and two were assigned to positive control treatments (hand instrumentation) > Microbial sampling was performed before and immediately after therapy on one tooth per quadrant with an interdental probing depth of 3 5 mm > Additionally, one tooth not undergoing therapy was selected in each half of the patient s mouth, and samples were taken twice (two negative control teeth) > In the test group, the spray of powder, air and water was aimed into the periodontal pocket for 5 sec per surface for subgingival plaque removal > Positive control treatment was performed using 4 sterile Gracey curettes, and treatment terminated when no more plaque was visible on the instrument > Plaque samples were taken by inserting sterile paper points to the bottom of the pocket for 10 sec > The mean reduction in colony-forming units was assessed by anaerobic culture > Periodontal maintenance treatments and plaque sampling were repeated three times at quarterly intervals Results: > The test treatment produced a significantly greater reduction in mean colony-forming units than the positive control treatment > No significant difference was observed between positive and negative controls 5

8 Natural Teeth Subjects 27 AIR-POLISHING v. HAND INSTRUMENTATION Environment Duration in vivo 3 months Subgingival plaque removal in buccal and lingual sites using a novel low abrasive air-polishing powder Petersilka GJ, Steinmann D, Häberlein I, Heinecke A, Flemmig TF Journal of Clinical Periodontology, 2003 April; 30(4): Aim: To evaluate the efficacy of subgingival plaque removal in buccal and lingual sites during supportive periodontal therapy with a glycine-based air-polishing powder Conclusion: In supportive periodontal therapy, air-polishing with glycine-based powder is more effective than hand INSTRUMENTATION in removing subgingival biofilm from periodontal pockets of 3 5 mm in depth, and offers greater patient comfort 6

9 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 27 subjects with generalized moderate to severe periodontitis were selected > Each subject had completed initial periodontal therapy and was receiving supportive periodontal therapy at regular three-month intervals Devices: > Test group: Treatment was performed using an EMS AIR-FLOW S1 and a glycine-based air-polishing powder (Clinpro Prophy Powder, 3M ESPE) at medium water and powder settings > Positive control: Treatment was performed using sterile Gracey curettes Nos 5/6, 7/8, 11/12 and 13/14 Procedure: > In a split-mouth design, the dentition was divided into two quadrants > In each of the test and control quadrants, one tooth with a pocket probing depth of 3 5 mm at the buccal or lingual site and without furcation invasion was selected for microbial sampling before and immediately after therapy > Two negative control teeth were selected for sampling the subgingival micro-flora twice, without preceding therapy > In the test group, the spray of powder, air and water was aimed into the periodontal pocket for 5 sec per surface for subgingival plaque removal > Positive control treatment was performed using 4 sterile Gracey curettes, and treatment terminated when no more plaque was visible on the instrument > Plaque samples were taken by inserting sterile paper points to the bottom of the pocket for 10 sec > The mean reduction in colony-forming units was assessed by anaerobic culture > Therapy and plaque sampling were repeated after three months > Subjects were asked to rate the perceived level of pain or discomfort on a visual analog scale as follows: 1 uncomfortable; 10 comfortable Results: > The test treatment produced a significantly greater reduction in mean colony-forming units than the positive control treatment > The test treatment was rated as more pleasant than hand instrumentation 7

10 Natural Teeth Subjects 60 EFFICACY OF GLYCINE POWDER Environment Duration in vivo & in vitro 3 months Subgingival debridement efficacy of glycine powder air-polishing Flemmig TF, Hetzel M, Topoll H, Gerss J, Haeberlein I, Petersilka GJ Journal of Periodontology, 2007 June; 78(6): Aim: To evaluate the subgingival debridement efficacy of glycine powder air-polishing in periodontal pockets of various depths, in order to determine the method s potential application in supportive periodontal therapy Conclusion: Glycine powder air-polishing for 5 seconds per surface is effective and time efficient in removing subgingival biofilm in periodontal pockets with a probing depth of approximately 4 mm 8

11 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 60 subjects aged 18 and over with severe periodontitis, a pocket depth of 6 mm at one or more sites and a hopeless prognosis were selected > The subjects were randomly assigned to subgingival debridement with a glycine-based powder on instrumented or non-instrumented teeth Devices: > Test group: EMS AIR-FLOW S1 and a glycine-based powder (Clinpro Prophy Powder, 3M ESPE) > Control group: Teeth which were neither instrumented nor treated with glycine powder air-polishing served as negative controls Procedure: > Each subject was randomly assigned one of the following interventions on one tooth > Subgingival debridement with glycine powder air-polishing was performed on: 1. Instrumented teeth (I) 1.1 Supra- and subgingival debridement was performed using curettes and sonic scalers 1.2 After therapy, subgingival recolonization was allowed to occur for three months under normal oral hygiene procedures performed by the patient 1.3 After three months, each surface (buccal, lingual, mesial and distal) of the investigated tooth was treated with glycine powder air-polishing for 5 sec 1.4 The powder was delivered using an EMS AIR-FLOW S1 device, with the spray of air, powder and water aimed directly into the periodontal pocket in a coronal to apical direction at an acute angle with the root surface 2. Non-instrumented teeth (NI) 2.1 Teeth that had not received any previous supra- and subgingival instrumentation were used and treated in the same manner as described in 1.3 and 1.4 > Before extraction, the gingival index and the probing depth were measured at 6 sites per tooth > After extraction, the teeth were stained with 0.5% toluidine blue and the subgingival debridement was assessed Results: > The median debridement depth was 2 mm in I teeth and 1.86 mm in NI teeth, while the median debrided root surface was 49.24% and 45.64% respectively > In anatomic pocket depths of 2 3 mm, the relative debridement depth ranged from 60 80% for the I teeth and 60 75% for the NI teeth (corresponding values for the debrided root surface: 60 70% in I teeth and 50 60% in NI teeth) > In control teeth, virtually all subgingival root surfaces were stained 9

12 Natural Teeth GLYCINE v. Sodium BICARBONATE v. HAND INSTRUMENTATION Subjects 10 Environment in vivo Duration 4 6 weeks Effect of glycine powder air-polishing on gingiva Petersilka GJ, Faggion Jr CM, Stratmann U, Gerss J, Ehmke B, Haeberlein I, Flemmig TF Journal of Clinical Periodontology, 2008 April; 35(4): Aim: To evaluate the safety and efficacy of glycine powder in comparison with sodium bicarbonate powder and hand instrumentation on gingival epithelium in vivo, using histological analysis Conclusion: Glycine powder air-polishing is safe and causes less gingival erosion than hand instrumentation and sodium bicarbonate air-polishing 10

13 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 10 subjects in total were selected > Each subject received full mouth supra- and subgingival debridement under local anesthesia and presented 4 to 6 weeks later with a 5 mm probing depth on at least 4 teeth in each of the two sextants Devices: > Test group: Teeth were debrided using an EMS AIR-FLOW S1 and a glycine-based powder (Clinpro Prophy Powder, 3M ESPE) > Control group: Teeth were debrided using an EMS AIR-FLOW S1 and a sodium bicarbonate powder (EMS AIR-FLOW Powder CLASSIC) > Control group: Hand instrumentation was performed using a sharp Gracey curette No 7/8 Procedure: > Three methods of root instrumentation were randomly assigned to one tooth in each sextant: Glycine powder air-polishing, sodium bicarbonate air-polishing and hand instrumentation > One tooth in each sextant remained untreated and served as a negative control. Debridement was limited to the buccal or lingual surface > Test teeth were debrided using either glycine powder or sodium bicarbonate, and the spray of air, powder and water was directed into the buccal or lingual aspect of the periodontal pocket at an angle of to the root surface. Treatment was performed for 5 sec per tooth > Debridement by hand instrumentation was performed until no more plaque was visible on the instrument > One set of biopsies was obtained from 4 teeth in one sextant immediately following debridement > A second set of biopsies was obtained from 4 teeth in the other sextant 14 days after debridement to assess soft tissue healing > Damaged gingival epithelium was assessed by light microscopy and quantified by a histological score as follows: 1 least erosion; 4 most erosion Results: > Glycine powder air-polishing resulted in minor erosions of the gingival epithelium (scores 1 and 2), while the positive control specimens displayed moderate to severe erosions with scores of 2 to 4 > There were significant differences between glycine powder air-polishing and the positive controls > After 14 days, the gingival epithelium was completely reestablished in all groups 11

14 Natural Teeth Subjects 50 AIR-POLISHING v. HAND INSTRUMENTATION Environment Duration in vivo 7 days Subgingival plaque removal using a new air-polishing device Moëne R, Décaillet F, Andersen E, Mombelli A Journal of Periodontology, 2010; 81:79-88 Aim: To evaluate patient acceptance, the safety and the short-term microbiologic effect of the AIR-FLOW PERIO Method in subjects on maintenance care, with residual pockets of 5 mm Conclusion: Subgingival air-polishing with AIR-FLOW PERIO is more time efficient than hand instrumentation Air-polishing is safe and more acceptable for the patients 12

15 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 50 subjects with a residual periodontal pocket depth of 5 mm were selected > Each subject received periodontal maintenance in two separate quadrants > None of the subjects presented obvious signs of persisting massive subgingival calculus Devices: > Test group: Glycine-based powder (25 μm, AIR-FLOW Powder PERIO) was introduced subgingivally for 5 sec using an EMS AIR-FLOW Master with PERIO-FLOW nozzle > Control group: Hand instrumentation was performed for 5 minutes per site, using Gracey curettes without anesthesia > Subjects were randomly assigned to receive test treatment in one quadrant and control treatment in another quadrant Procedure: > The following clinical variables were recorded at 6 sites per tooth: Plaque index, pocket depth, bleeding on probing and recession > Two days prior to subgingival treatment, subgingival plaque samples were collected from the two study sites by inserting sterile paper points to the bottom of the pocket > Oral tissue safety was evaluated based on a visual inspection for change in color and texture, signs of abrasion or any other irregularity of the soft and hard tissues in the oral cavity > After removal of the supragingival hard and soft deposits, all pockets 5 mm in the test quadrant were treated with AIR-FLOW using the disposable PERIO-FLOW nozzle and AIR-FLOW Powder PERIO. The control group was treated with hand instrumentation > The time spent on subgingival treatments was noted for both groups > Subjects were asked to rate the perceived level of pain or discomfort on a visual analog scale as follows: 0 uncomfortable; 10 comfortable > After 7 days, subgingival plaque samples were collected from the two study sites. The plaque index, bleeding on probing and oral tissue changes were noted respectively Results: > Pain: Perceived pain was lower with air-polishing > Comfort: Air-polishing was rated as more comfortable than hand instrumentation (visual analog scale 9 compared to 2.2) > Time: Less time was required for the test treatment (0.5 min per site with air-polishing) than for the control treatment (1.4 min per site with hand instrumentation) > Microbiological level: No significant differences were seen 13

16 Natural Teeth Subjects 30 AIR-POLISHING v. SCALING AND ROOT PLANING Environment Duration in vivo 3 months Randomized controlled trial assessing efficacy and safety of glycine powder air-polishing in moderate to deep periodontal pockets Flemmig TF, Arushanov D, Daubert D, Rothen M, Mueller G, Leroux BG Journal of Periodontology 2012 April; 83(4) Aim: To evaluate the efficacy and safety of subgingivally applied glycine powder air-polishing in removing bacterial biofilm in moderate to deep periodontal pockets, in comparison to conventional scaling and root planing Conclusion: Subgingival glycine powder air-polishing with AIR-FLOW PERIO is more effective in removing subgingival biofilm in moderate to deep periodontal pockets than scaling and root planing The method is safe and comfortable for patients Full-mouth glycine powder air-polishing may result in a beneficial shift of the oral microbiota 14

17 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 30 subjects with chronic periodontitis and having completed initial periodontal therapy were selected > Each subject had a pocket probing depth of 4 9 mm on at least two teeth, with 3 mm of residual alveolar bone and detectable levels of Porphyromonas gingivalis and Tannerella forsythia Devices: > Test group: Treatment was performed using an EMS AIR-FLOW Master with PERIO-FLOW nozzle and glycine-based powder (25 μm, AIR-FLOW Powder PERIO) > Control group: Scaling and root planing was performed using curettes and scalers, followed by coronal polishing with rubber cups and polishing paste Procedure: > In the test group, the nozzle was inserted mesially, buccally, distally and lingually into the periodontal pocket until resistance was felt, and treatment was performed for 5 sec/site. Supragingival and subgingival biofilm in shallow periodontal pockets ( 3 mm) was removed by applying glycine-based powder supragingivally > No time limit was set for scaling and root planing(control group) > Both groups were asked to rinse with Chlorhexidine 0.12% for 2 min twice daily for two weeks > Subgingival biofilm was collected from the sites immediately before and after subgingival debridement > The following clinical variables were recorded at baseline, 10 and 90 days after treatment: Periodontal pocket depth, bleeding on probing, gingival recession and plaque index Results: > At baseline and at day 10, subgingival glycine powder air-polishing resulted in significantly lower total viable counts in moderate to deep pockets, in comparison to scaling and root planing > At day 90, total P. gingivalis counts in the oral cavity were significantly reduced following full-mouth glycine powder air-polishing, in comparison to scaling and root planing > Comfort levels were high for both treatments > No adverse effects were observed with glycine powder air polishing 15

18 Natural Teeth Subjects 20 AIR-POLISHING v. ULTRASONICS Environment Duration in vivo 60 days Subgingival debridement of periodontal pockets by air polishing in comparison with ultrasonic instrumentation during maintenance therapy Wennström JL, Dahlén G, Ramberg P Journal of Clinical Periodontology 2011; 38: Aim: To evaluate the clinical and microbiological effects and perceived treatment discomfort of root debridement by subgingival airpolishing in comparison with ultrasonic instrumentation in patients on supportive periodontal therapy Conclusion: No significant differences in clinical or microbiological outcomes were observed between the two methods of subgingival root debridement of moderate/deep PERIODONTAL pockets, in supportive periodontal therapy patients Air-polishing with AIR-FLOW PERIO was judged to be more comfortable 16

19 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 20 subjects undergoing treatment for moderate/advanced chronic periodontitis and involved in a supportive periodontal therapy program were selected > Two sites with a probing pocket depth of 5 8 mm and bleeding on probing in each of two quadrants were randomly assigned to one of the two groups Devices: > Test Group: Air-polishing was performed for two times 5 sec per site using an EMS AIR-FLOW Master with PERIO-FLOW Nozzle and glycine-based powder (25 μm; AIR-FLOW Powder PERIO). Water and powder were set at 75% > Control Group: Ultrasonic instrumentation was performed for 30 sec per site using an EMS Piezon Master 400 and EMS SWISS INSTRUMENT Perio Slim. Power was set at 75% Procedure: > The following clinical variables were recorded at baseline, and 14 and 60 days post-treatment: Oral hygiene status, marginal gingival bleeding, periodontal pocket depth, relative attachment level and bleeding on probing > No anesthesia was used during treatment > Microbiological analysis of subgingival samples was performed immediately before and after debridement, as well as two and 14 days post-treatment > The presence of 12 species associated with periodontal disease was evaluated Results: > Significant reduction in bleeding on probing, periodontal pocket and relative attachment levels were found after two months, in both groups > Significant reductions in periodontitis-associated bacterial species were found immediately and two days after treatment in both groups > No statistically significant differences were observed in clinical and microbiological variables between the two treatment procedures at any of the examination intervals > Air-polishing with AIR-FLOW was judged to be more comfortable than ultrasonic debridement 17

20 Natural Teeth comparison of different air-polishing powders Subjects Environment Duration 420 Extracted teeth in vitro N/A In vitro analysis of the effects of novel air polishing devices on human teeth Preliminary result Bühler J, Schmidli F, Weiger R, Walter C EUROPERIO 2012 abstract Aim: To evaluate the influence of different types of air-polishing powders on tooth dentine structure Conclusion: POWDER NATURE HAS A MAJOR INFLUENCE ON dentine GLYCINE-BASED POWDERS (B AND C) HAVE PROVEN TO BE THE SMOOTHEST POWDERS WITH THE LOWEST ABRASIVITY LEVELs SODIUM BICARBONATE (a) has a medium influence on dentine structure BIOACTIVE GLASS (D) Was ASSOCIATED WITH the SIGNIFICAnTLY HIGHEst SURFACE ALTERATIONS 18

21 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 420 extracted human teeth were selected Devices: > 4 different powders have been tested : A. EMS AIR-FLOW powder CLASSIC (sodium bicarbonate) B. EMS AIR-FLOW powder SOFT (glycine) C. EMS AIR-FLOW powder PERIO (glycine) D. OSspray Sylc TM powder (bioactive glass) Procedure: > All 420 extracted teeth were randomly assigned treatment with one of the 4 powders > Each root dentine surface was divided into two areas, one treated with the assigned powder and one left untreated (control group) > Conditions for the 4 powders were set identically: 5 seconds, at a 2 mm distance, with a 90 angulation and 2.2 bars (pressure inside the powder chamber during use) > The surface waviness (Pa), indicating crater formation, as well as the maximum surface roughness (rz) were measured. Geometric mean ratios were determined between test and control areas and deviation from baseline determined as follows: 1 - identical to baseline after treatment; > 1 - factor of deviation from baseline after treatment Results: > Surface waviness (Pa) ratio is significantly lower with glycine-based powders: powder (D) 6.9 > powder (A) 5.0 > powder (C) 3.2 > powder (B) 1.4 > Surface micro alteration (rz) ratio is significantly lower with glycine-based powders: powder (D) 3.2 > powder (A) 1.9 > powder (B) 1.4 > powder (C) 1.2 > Air-polishing with bioactive glass led to significantly higher values compared to the three other powders > The study is continuing in order to better understand the shown differences 19

22 Natural Teeth Subjects 40 air-polishing v. hand instrumentation Environment Duration in vivo 3 months CLINICAL OUTCOMES FOLLOWING SUBGINGIVAL APPLICATION OF A NOVEL ERYTHRITOL POWDER BY MEANS OF AIR POLISHING IN SUPPORTIVE PERIODONTAL THERAPY: A RANDOMIZED, CONTROLLED CLINICAL STUDY Hägi TT, Hofmänner P, Salvi GE, Ramseier CA, Sculean A Quintessence International 2013 Nov-Dec; 44(10): Aim: To evaluate the clinical efficacy, patient acceptance and safety of air-polishing with a new erythritol powder in supportive periodontal therapy, in comparison to conventional scaling and root planning Conclusion: Air-polishing done with the new erythritol-based powder is safe, comfortable and time efficient for the removal of subgingival biofilm during supportive periodontal therapy 20

23 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 40 subjects with bleeding on probing and pocket depths of 4 mm but without visible and tactile subgingival calculus were selected > In all patients, treatment for moderate to advanced chronic periodontitis was completed and they were receiving supportive periodontal therapy Devices: > Test Group: treatment was performed using an EMS AIR-FLOW Master with PERIO-FLOW Nozzle and erythritol-based powder (14 μm; AIR-FLOW Powder PLUS without Chlorhexidine) > Control Group: hand instrumentation was performed using Gracey curettes (Nos 11/12, 13/14; Hu-Friedy) and universal and Golden-Fox curettes (GX4, GX2; Deppeler) Procedure: > Subjects were randomly divided into two groups A and B > Probing pocket depth, clinical attachment level, percentage of bleeding on probing positive sites and full mouth plaque index were assessed at baseline and after 3 months > Supportive periodontal therapy was provided at baseline and after 3 month follow up > Test sites were treated subgingivally for 5 secs each with erythritol-powder air-polishing using the nozzle in a coronal to apical direction with vertical strokes > Positive control treatment was performed using curettes, and treatment terminated when no more plaque was visible on the instrument > No anesthesia was administered in any group > Subjects were asked to rate the perceived level of pain or discomfort on a visual analog scale as follows: 1 uncomfortable; 10 comfortable Results: > At 3 months follow up, bleeding on probing levels at the test and control sites decreased to 45.1% and 50.6% > Significant improvement in mean probing pocket depth in both groups at baseline and 3 months > Slight gain in mean clinical attachment level between baseline and 3 months in both groups > Patient acceptability (comfort) was statistically significantly higher in the test group > No adverse reaction in either group, hence proving the safety of the new powder > Treatment with AIR-FLOW was much faster (5 sec/ site) in comparison to hand instrumentation (85 secs/ site) 21

24 Natural Teeth Subjects 30 air-polishing v. ultrasonics Environment Duration in vivo 12 months Twelve-month evaluation of sub gingival air polishing during maintenance Müller N, Moëne R, Cancela J, Mombelli A Division of oral Physiotherapy and Periodontology, school of Dental Medicine, University of Geneva, Switzerland Preliminary results, study publication expected in 2014 Aim: To evaluate the advantages of an air-polishing device using a new erythritol-based powder in patients on maintenance care with residual pockets Conclusion: Air-polishing with AIR-FLOW Powder plus had a high patient compliance and decreased the number of residual pockets with Bleeding on probing significantly 22

25 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 30 healthy subjects on maintenance care with residual pocket depth of 4 mm were selected Devices: > Test Group: Air-polishing was performed using an EMS AIR-FLOW Master Piezon with PERIO-FLOW nozzle and erythritol-based powder containing Chlorhexidine (14 μm; AIR-FLOW Powder PLUS) > Control Group: Ultrasonic instrumentation was performed using an EMS AIR-FLOW Master Piezon and EMS SWISS INSTRUMENT Perio Slim Procedure: > Sites with 4 mm probing depth were treated at baseline and 3, 6 and 9 months post-treatment > The following clinical variables were recorded: pocket depth, bleeding on probing > Subjects were asked to rate the perceived level of pain or discomfort on a visual analog scale as follows: 1 uncomfortable; 10 comfortable Results: > Significant reduction in pocket depth from baseline to month 12 were found in both groups > Significant reductions in the percentage of persisting pockets and bleeding on probing was found in the test group, whereas the difference was not statistically significant in the control group > Air-polishing with AIR-FLOW using the new erythritol-based powder was judged to be much more comfortable than ultrasonic instrumentation 23

26 Natural Teeth AIR-POLISHING v. ULTRASONICS v. HAND INSTRUMENTATION A paradigm shift in mechanical biofilm management? Subgingival air polishing: a new way to improve mechanical biofilm management in the dental practice Bastendorf KD, Becker C, Bush B, Einwag J, Lanoway C, Platzer U, Schmage P, Schoeneich B, Walter C, Wennström JL, Flemmig TF, Sculean A Consensus conference during the Europerio 7 Congress in Vienna, Austria, on 7 June 2012 Quintessence International, 2013 July/August; 44(7): Aim: To review current evidence from the literature during a consensus conference held during the Europerio 7 Congress in Vienna (2012). To reach a consensus on the clinical relevance of the subgingival use of air polishing and to make practical recommendations for the clinician Conclusion: Subgingival air-polishing with the new generation of powders is efficient, fast, comfortable and safe 24

27 EMS Original Method AIR-FLOW Perio Scientific Evidence Results: > Air-polishing devices have shown to be efficient in removing both sub and supragingival biofilm and stains > The new generation of powders and devices with subgingival nozzles provide better access to subgingival and interdental areas > In shallow pockets up to 4 mm and in deeper pockets 5 mm, air-polishing removes biofilm significantly more efficiently than hand curettes > Full-mouth glycine powder air-polishing results in a significantly decreased load of Porphyromonas gingivalis in the oral cavity > Subgingival biofilm removal with air-polishing is considerably faster than hand instrumentation or ultrasonics > Glycine-based air-polishing is perceived as more comfortable by the patients than hand instrumentation or ultrasonics > Subgingival air-polishing with glycine-based powder is safe if used as per recommendation 25

28 IMPLANTS COMPARISON OF DIFFERENT AIR-POLISHING POWDERS Subjects 6 Environment in vivo & in vitro Duration 16 days Influence of different air-abrasive powders on cell viability at biologically contaminated titanium dental implants surfaces Schwarz F, Ferrari D, Popovski K, Hartig B, Becker J Journal Biomed Mater Res B Appl Biomater, 2009 January; 88(1):83-91 Aim: To evaluate the influence of different types of air-polishing powder on cell viability on biologically contaminated titanium surfaces Conclusion: Cell viability on biologically contaminated titanium surfaces is mainly influenced by the type and particle size of the powder. Glycine-based powders have proven to be efficient without altering the titanium surfaces 26

29 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 6 healthy non-smoking subjects with a good level of oral hygiene and no sign of periodontal disease were selected Devices: > EMS AIR-FLOW S1. Power and water were set at 4.5 bar static pressure and 60 ml water/min > 4 powders were tested: AIR-FLOW Powders SOFT, PERIO and CLASSIC (EMS), and Clinpro Prophy Powder (3M ESPE) > Titanium discs (Straumann) Procedure: > Prior to investigation all subjects received professional tooth cleaning > Each subject was fitted with an acrylic appliance for the upper jaw, with 4 titanium discs to collect supragingival biofilm > After staining with erythrosine dye, only those specimens showing homogenous biofilm formation were included in the study > A total of 128 titanium discs were collected and randomly assigned to an AIR-FLOW system using one of the 4 different types of powder > A standard handpiece was mounted on a translation stage and guided onto the implant surface using two different distances (1 and 2 mm) and angulations (30 and 90 ) > A total of 8 titanium discs were included in each group and fixed on a translation stage > Each titanium disc received a single (1 ) and a repeated (2 ) treatment. Treatment time was set at 20 sec > Non-contaminated and untreated titanium surfaces served as controls > Residual biofilm areas (%), surface alterations (1 and 2 ) and cell viability were assessed Results: > Residual biofilm areas: After a single surface treatment, all groups revealed a significant decrease of mean residual biofilm areas with both nozzle distances (1 and 2 mm) and angulations (30 and 90 ). After repeated surface treatments, the biofilm was completely removed > Repeated treatment: Surface alteration was observed with the EMS AIR-FLOW Powder CLASSIC, while the other powders (EMS AIR-FLOW Powders SOFT and PERIO, and Clinpro Prophy Powder, 3M ESPE) did not produce any alterations at either distance or angulation > Cell viability: The highest mean values were recorded in the control group, followed by the AIR-FLOW Powder CLASSIC group. They were significantly higher than those recorded in the AIR-FLOW Powder SOFT, Clinpro Prophy Powder and AIR-FLOW Powder PERIO groups 27

30 IMPLANTS Subjects 33 AIR-POLISHING v. hand instrumentation Environment Duration in vivo 6 months Non-surgical treatment of periimplantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine: a prospective, randomized, controlled clinical study Sahm N, Becker J, Santel T, Schwarz F Journal of Clinical Periodontology; 2011; 38: Aim: To evaluate and compare the efficacy of an air-polishing device with mechanical debridement and local application of Chlorhexidine for non-surgical treatment of periimplantitis Conclusion: Both treatment procedures resulted in comparable but limited clinical attachment level gains at 6 months Air-polishing (EMS AIR-FLOW PERIO) was associated with significantly higher reductions in bleeding on probing than mechanical debridement 28

31 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 33 subjects with at least one screw-type titanium implant, showing clinical and radiographic signs of initial to moderate periimplantitis, were selected Devices: > Test group: Treatment was performed using an EMS AIR-FLOW Master with PERIO-FLOW nozzle and glycine-based powder (25 μm, AIR-FLOW Powder PERIO) > Control group: Mechanical debridement was performed using carbon curettes (Straumann), followed by the application of chlorhexidine (GlaxoSmithKline) Procedure: > 4 weeks before the treatment, all subjects received professional supragingival implant and tooth cleaning using rubber cups and polishing paste > The same procedure was repeated at baseline, and 2, 4, 6, 8, 10, 12, 16, 20 and 24 weeks after treatment > Treatments for both groups were performed under anesthesia > Using the single-use PERIO-FLOW nozzle, glycine-based powder was delivered subgingivally along the mesial, distal, vestibular and oral surfaces for 5 sec/site > Mechanical debridement was carried out using carbon curettes until the operator was satisfied with the calculus removal. This was followed by pocket irrigation with 0.1% chlorhexidine digluconate solution, and submucosal application of 1% chlorhexidine gel > The following clinical variables were evaluated at baseline, and three and 6 months post-treatment: Plaque index, bleeding on probing, periodontal pocket depth, mucosal recession and clinical attachment level > All measurements were taken at 6 aspects per implant Results: > At 6 months, the air-polishing group revealed significantly higher reductions in bleeding on probing in comparison to sites treated with mechanical debridement > The clinical attachment level gains and periodontal pocket depth reductions were comparable 29

32 IMPLANTS Subjects 42 AIR-POLISHING v. laser Environment Duration in vivo 6 months Treatment of periimplantitis using an Er:YAG laser or an air-abrasive device: a randomized clinical trial Renvert S, Lindahl C, Roos Jansaker AM, Persson GR Journal of Clinical Periodontology 2011; 38:65-73 Aim: To compare the treatment effects of air-polishing and Er:YAG laser monotherapy in subjects with severe periimplantitis Conclusion: In patients with severe periimplantitis, the results of therapy after 6 months are similar with both AIR-FLOW PERIO and Er:YAG laser HOWEVER, IN PATIENTS WITH SEVERE PERIIMPLANTITIS, BOTH TREATMENT MODALITIES ARE EFFICIENT ONLY TO A CERTAIN DEGREE 30

33 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > Two groups of 21 subjects were randomly assigned a one-time treatment with an air-polishing device or an Er:YAG laser > Each subject presented at least one dental implant with bone loss > 3 mm at implants on intraoral radiographs, and a periodontal pocket depth 5 mm with bleeding > Subjects with systemic complications and under medication were excluded from the study Devices: > Laser group: Er:YAG laser (KaVo KEY Laser 3) at an energy level of 100 mj/pulse and 10 Hz > Air-polishing group: EMS AIR-FLOW Master, PERIO-FLOW nozzle and glycine-based powder (25 µm; AIR-FLOW Powder PERIO) Procedure: > The following clinical variables were recorded at baseline and at 6 months: Full mouth plaque score, local plaque score (around the implant sites), probing depth and presence or absence of bleeding on probing at 4 sites per implant > The amount of bleeding was graded as follows: 0 no bleeding; 1 point of bleeding; 2 line of bleeding; 3 drop of bleeding > Intraoral radiographs were taken at baseline and at 6 months; suprastructures were removed before treatment > Implants in the air-polishing group were treated using AIR-FLOW PERIO. The nozzle was placed mesially, distally, lingually and buccally in the pocket for 15 sec in each position, and circumferentially in the pocket around the implant > Implants in the laser group were treated with a cone-shaped sapphire tip in a parallel mode, using a semicircular motion around the circumferential pocket area of the implant Results: > No statistically significant differences in the gingival index, plaque index and bleeding on probing were found at baseline in either group > The decrease in bleeding on probing and suppuration was significant in both groups > The periodontal pocket depth reduction between baseline and 6 months was 0.8 mm in the laser treated group and 0.9 mm in the group treated by air-polishing > A positive treatment outcome periodontal pocket depth reduction 5 mm and gain or no loss of bone was obtained in 47% of the air-polishing group and 44% of the laser group 31

34 IMPLANTS Subjects 15 AIR-POLISHING v. hand instrumentation Environment Duration in vivo 1 month The effect of glycinepowder AIR-FLOW and hand instrumentation on peri implant soft tissues: a Split mouth Pilot study Mussano F, Rovasio S, Schierano G, Baldi I, Carossa S Int J Prosthodontol 2013; 26:42-44 Aim: To compare the efficacy of traditional teflon curettes with an air-polishing device using glycine-based powder in the periodontal therapy of dental implants Conclusion: Air-polishing with AIR-FLOW PERIO was observed to be more effective and less invasive than Teflon curettes for maintenance of periimplant soft tissues 32

35 EMS Original Method AIR-FLOW Perio Scientific Evidence MATERIAL AND METHODS: Test group and control group: > 15 edentulous subjects with overdentures supported by 2 implants in the mandibular region were selected > Each of the 2 implants per subject was randomly assigned to either hand instrumentation or air-polishing Devices: > Test group: Air-polishing was performed using an EMS AIR-FLOW Master with PERIO-FLOW nozzle and glycine-based powder (25 μm, AIR-FLOW Powder PERIO) > Control group: Mechanical debridement was performed using teflon curettes (Universal Implant Deplaquer, Hawe Neos) for subgingival deposits and a scaler (IH 6/7 tips; Hu-Friedy) for removal of plaque from the abutments Procedure: > The following clinical variables were evaluated before treatment (T0), at one hour (T1), 1 week (T2) and 4 weeks (T3) post-treatment: bleeding on probing, periodontal pocket depth and bacterial count within the gingival sulcus > Periodontal probing was done using a plastic probe (PerioWise, Premier Dental) at T0, T2 and T3 > Microbial analysis from perio-implant sulcus was done by inserting sterile paper points at all time points > Air-polishing was performed for 5 sec per site whereas the time spent on hand instrumentation was not noted Results: > A significant effect modification of the Glycine Air-polishing compared to hand instrumentation with respect to time was found for periodontal pocket depth, bleeding on probing and bacterial count 33

36 ORIGINAL AIR-FLOW METHOD SUBGINGIVAL } ORIGINAL AIR-FLOW HANDPIECE } > Effective air-polishing in the subgingival border area (shallow pockets < 4 mm) > Reliable, fast and efficient for the practice stress-free and comfortable for the patient (no curettes no noise!) > Gentle application of biokinetic energy no damage to the epithelium or connective tissue, no scratching of the tooth surface ORIGINAL PERIO-FLOW HANDPIECE } > Effective removal of biofilm in deep periodontal pockets (up to 10 mm) > Sustained reduction in bacteria prevents tooth loss (periodontitis!) or loss of implants (periimplantitis!) > Uniform turbulence of air-powder mixture and of rinse water due to patented PERIO-FLOW nozzle 34

37 > Grain size ~ 25 μm, glycine-based > Grain size ~ 14 μm, erythritol-based AIR-FLOW POWDERs PERIO and plus } > Subgingival and supragingival use > For efficient biofilm removal without damage to soft tissues, enamel, dentine or cementum > Safe and conservative even on titanium surfaces of implants BEYOND THE BOUNDARIES OF CONVENTIONAL PROPHYLAXIS 35

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