Efficacy of the additional use of subgingival air polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial

Abstract

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.

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.…”

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 .…”

Treatment of peri-implantits

“…Moreover, promising effects in terms of titanium cleaning efficacy were seen (Tastepe, et al, 2018;Drago, et al, 2017). When erythritol air-polishing was compared to scaling and rootplaning in periodontal maintenance studies and in non-surgical periodontitis treatment studies, comparable clinical and microbiological results were found Hägi, et al, 2015;Park, et al 2018;Jentsch, et al, 2020;Mensi, et al, 2021). More recently, a study by Cosgarea et al (2021) showed that erythritol air-polishing during periodontal surgery may represent a valuable adjunct following calculus removal or as minimally invasive treatment for root surfaces without calculus.…”