Objectives To date, scarce evidence exists around the application of subgingival air polishing during treatment of severe periodontitis. The aim of this study was to evaluate the benefits of subgingival air polishing during non-surgical treatment of deep bleeding pockets in stages III-IV periodontitis patients Materials and methods Forty patients with stages III-IV periodontitis were selected, and pockets with probing depth (PD) 5-9 mm and bleeding on probing (BoP) were selected as experimental sites. All patients underwent a full-mouth session of erythritol powder supragingival air polishing and ultrasonic instrumentation. Test group received additional subgingival air polishing at experimental sites. The proportion of experimental sites shifting to PD ≤ 4 mm and no BoP at 3 months (i.e., nonbleeding closed pockets, NBCPs) was regarded as the primary outcome variable. Results The proportion of NBCP was comparable between test and control group (47.9 and 44.7%, respectively). Baseline PD of 7-9 mm, multi-rooted teeth and the presence of plaque negatively influenced the probability of obtaining NBCP. Conclusions The additional application of subgingival air polishing does not seem to provide any significant clinical advantage in achieving closure at moderate to deep bleeding pockets in treatment of stages III-IV periodontitis patients. The study was registered on Clinical Trials.gov (NCT04264624). Clinical relevance While air polishing can play a role in biofilm removal at supragingival and shallow sites, ultrasonic root surface debridement alone is still the choice for initial treatment of deep bleeding periodontal pockets.

The oral cavity is the natural habitat of a heterogeneous population of bacteria. 1 Both soft and hard surfaces are the substrate where microorganisms adhere and grow, forming the oral biofilm. 1,2 Biofilm quantity and complexity increase with time and affect the environment, leading to the development of caries, gingivitis 2,3 and periodontitis, 4 according to individual susceptibility and risk factors. Vice versa, the environment and local factors can influence the growth of biofilm, leading to its diversification in distinct areas even of the same tooth. 2 The regular disruption of biofilm through professional mechanical plaque removal and home oral hygiene is a critical point in the prevention of caries and periodontal disease. 5-8 Professional mechanical plaque removal in cariology involves biofilm and calculus removal from the supra-gingival area while, in periodontology, it extends to the sub-marginal space. 8 While manual and ultrasonic instrumentation constitutes the traditional professional mechanical plaque removal procedure, air-polishing with low-abrasiveness

Air-polishing with low abrasiveness powders is fast arising as a valid and mini-invasive instrument for the management of biofilm colonizing dental implants. In general, the reported advantage is the efficient removal of plaque with respect to the titanium integrity. In the present study, we evaluated the in situ plaque removal and the preventive efficacy in forestalling further infection of an innovative erythritol/chlorhexidine air-polishing powder and compared it with sodium bicarbonate. Accordingly, two peri-implantitis-linked biofilm formers, strains Staphylococcus aureus and Aggregatibacter actinomycetemcomitans, were selected and used to infect titanium disks before and after the air-polishing treatment to test its ability in biofilm removal and re-colonization inhibition, respectively. Biofilm cell numbers and viability were assayed by colony-forming unit (CFU) count and metabolic-colorimetric (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) (XTT) assay. Results demonstrated that air-polishing performed with either sodium bicarbonate or erythritol/chlorhexidine was effective in reducing bacteria biofilm viability and number on pre-infected specimens, thus showing a similar ability in counteracting existing infection in situ; on the other hand, when air-polished pre-treated disks were infected, only erythritol/chlorhexidine powder showed higher post-treatment biofilm re-growth inhibition. Finally, surface analysis via mechanical profilometry failed to show an increase in titanium roughness, regardless of the powder selected, thus excluding any possible surface damage due to the use of either sodium bicarbonate or erythritol/chlorhexidine.

Air-polishing with low abrasiveness powders is fats arising as a valid and mini-invasive instrument for the management of biofilm colonizing dental implants. The reported advantage is the efficient removal of plaque with respect of the titanium integrity. In the present study, we evaluated the in-situ plaque-removal and continual the post-treatment anti-bacterial efficacy of an innovative erythritol/chlorhexidine air-polishing powder and compared it with sodium bicarbonate. Two peri-implantitis-linked biofilm formers strains Staphylococcus aureus and Aggregatibacter actinomycetemcomitans were selected and used to infect titanium disks before and after the air-polishing treatment. Cells number and viability were assayed by colonies forming units (CFUs) count and metabolic-colorimetric (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) (XTT) assay. Air-polishing performed with either sodium bicarbonate or erythritol/chlorhexidine was effective in reducing bacteria biofilm viability and number onto pre-infected specimens, while erythritol/ chlorhexidine showed a higher post-treatment biofilm re-growth inhibition. Surface analysis via mechanical profilometry failed to show an increase in titanium roughness, regardless of the powder selected.

This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Oral biofilm is a dynamic bacterial community embedded in an extracellular polymeric matrix adherent to a substrate. 1 Periodontal health is strictly dependent on the daily self-performed disruption of dental biofilm, in combination with regular professional mechanical plaque removal (PMPR). 2,3 Patients able to keep their plaque index below 20% seem to have a lower incidence of caries and tooth loss. 4 Repeated and individually tailored oral hygiene instructions (OHI) provided after a session of PMPR seem to maintain periodontal health for up to three years. 3 Given the positive effect of OHI, particular attention should be paid to the self-care instruments

Objectives To date, scarce evidence exists around the application of subgingival air-polishing during treatment of severe periodontitis. The aim of this study was to evaluate the effect on the health-related and periodontitis-related subgingival microbiome of air-polishing during non-surgical treatment of deep bleeding pockets in stage III–IV periodontitis patients. Materials and methods Forty patients with stage III–IV periodontitis were selected, and pockets with probing depth (PD) 5–9 mm and bleeding on probing were selected as experimental sites. All patients underwent a full-mouth session of erythritol powder supragingival air-polishing and ultrasonic instrumentation. Test group received additional subgingival air-polishing at experimental sites. Subgingival microbial samples were taken from the maxillary experimental site showing the deepest PD at baseline. Primary outcome of the first part of the present study was the 3-month change in the number of experimental sites. Additional analysis of periodontal pathogens and other sub-gingival plaque bacteria sampled at one experimental site at baseline and 3 months following treatment was performed through a real-time quantitative PCR microarray. Results In the test group, a statistical increase of some health-related species was observed (Abiotropha defectiva, Capnocytophaga sputigena, and Lautropia mirabilis), together with the decrease of pathogens such as of Actinomyces israelii, Catonella morbi, Filifactor alocis, Porphyromonas endodontalis, Sele-nomonas sputigena, Tannerella forsythia, Treponema denticola, and Treponema socranskii. In the control group, statistical significance was found only in the decrease of Filifactor alocis, Tannerella forsythia, and Treponema socranskii. Conclusions The addition of erythritol-chlorhexidine powder seems to cause a shift of the periodontal micro-biome toward a more eubiotic condition compared to a conventional treatment. The study was registered on Clinical Trials.gov (NCT04264624). Clinical relevance Subgingival air-polishing could help re-establishing a eubiotic microbioma in deep bleeding periodontal pockets after initial non-surgical treatment.

Una nuova metodica di rimozione del biofilm con polvere di eritritolo guidata da rilevatore di placca A new method for biofilm removal with erythritol powder guided by disclosing agent Ricevuto il 28 novembre 2016 Accettato il 17 gennaio 2017