Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy – a randomized clinical trial

Abstract

Background: This study was aimed to investigate if the adjunctive use of erythritol air-polishing powder applied with the nozzle-system during subgingival instrumentation (SI) has an effect on the outcome of non-surgical periodontal treatment in patients with moderate to severe periodontitis. Methods: Fourty-two individuals with periodontitis received nonsurgical periodontal therapy by SI without (controls, n=21) and with adjunctive air-polishing using nozzle + erythritol powder (test, n=21). They were analyzed for the clinical variables BOP (primary outcome at six month), probing depth (PD), attachment level (AL), four selected microorganisms and two biomarkers at baseline, before SI as well as three and six months after SI. Statistical analysis included nonparametric tests for intra- and intergroup comparisons. Results: In both groups, the clinical variables probing depth (PD), attachment level and BOP significantly improved three and six months after SI. The number of sites with PD ≥ 5mm was significantly lower in the test group than in the control group after six months. At six months vs. baseline, there were significant reductions of Tannerella forsythia and Treponema denticola counts as well as lower levels of MMP-8 in the test group. Conclusions: Subgingival instrumentation with adjunctive erythritol air-polishing powder does not reduce BOP. But it may add beneficial effects like reducing the probing depth measured as number of residual periodontal pocket with PD ≥ 5mm when compared with subgingival instrumentation only. Clinical relevance: The adjunctive use of erythritol air-polishing powder applied with the nozzle-system during SI may improve the clinical outcome of SI and may reduce the need for periodontal surgery. Trial registration: The study was retrospectively registered in the German register of clinical trials, DRKS00015239 on 6th August 2018, https://www.drks.de/drks_web/navigate.do?navigationId =trial.HTML&TRIAL

Efficacy of erythritol powder air‐polishing in active and supportive periodontal therapy: A systematic review and meta‐analysis

“…From the eight included studies (Table 2), four trials 19,26,27,29 were conducted during the SPT phase, and four trials 22–25 were conducted during the APT. Five RCTs 19,22–24,27 followed a parallel design, whereas three 25,26,29 used a split‐mouth design.…”

“…The minimum mean age was 44.3 years, 23 and the maximum mean age was 61 years 26 . Seven studies included smokers 19,22–24,26,27,29 ; however, in two of these studies, individuals smoking more than 7 24 and 10 23 cigarettes per day were excluded. In the remaining study, 25 inclusion or exclusion of smokers was not reported.…”

“…Therefore, EPAP is more acceptable as an alternative to SPT but only as adjunctive during APT due to its limitation in removing large and firmly attached masses of calculus and other hard deposits 21 . Significant improvement in periodontal clinical parameters including CAL gain and reduction of PPD and BoP was observed when EPAP was used either as adjunctive to APT 22–25 or as a monotherapy during SPT 19,26,27 . Furthermore, erythritol has antibacterial properties against periodontal pathogens 28 .…”

“…Furthermore, erythritol has antibacterial properties against periodontal pathogens 28 . The use of EPAP for air‐flowing periodontal pockets was reported to yield microbiological outcomes similar to that obtained by subgingival debridement 24,26,27,29 . Additionally, measurement of pain perception and discomfort during SPT favoured EPAP over conventional treatment 19,26,29 .…”

Comparison of three full‐mouth concepts for the non‐surgical treatment of stage III and IV periodontitis: A randomized controlled trial

“…It can be assumed that (i) in multi-rooted teeth the extensive use of antiseptics with high substantivity (chlorhexidine) could in part compensate the impaired mechanic accessibility of furcation regions, and (ii) additional air-polishing might have particular benefits in moderate pockets.Application of erythritol air-polishing in addition to conventional instrumentation for non-surgical therapy has recently been investigated by three groups. WhilePark et al (2018) andMensi et al (2021) could not prove any clinical advantages over SRP,Jentsch et al (2020) showed a higher reduction of residual periodontal pockets with PPD ≥5 mm after 6 months compared to SRP alone. Differences in the study design and the definition of experimental sites might explain the inhomogeneous outcomes.…”