Supra- and subgingival polishing transform preventive care

Glycine powder appears to inhibit bacterial recolonization on implants

March 21, 2018

Originally Published On:

RDH Magazine

Our role as dental hygienists includes preventing the progression of disease. Traditionally, we remove periodontal pathogens and biofilm both subgingivally and supragingivally through hand and ultrasonic oscillation. However, removing calculus and biofilm through debridement, repeated instrumentation with hand and ultrasonic technologies can cause gingival recession and loss of tooth structure. Air polishing technology empowers hygienists to effectively remove more bacteria with a reduced risk of gingival trauma~~1

Traditionally, polishing is performed with a rubber cup with the intention of removing stain and biofilm. Despite efforts to selectively polish, traditionally removing stain with a cup and prophy cup can lead to abrasion of the tooth.~~2

Alternatively, air polishing removes tenacious stain and bacteria without adverse effects. Air polishing is a technology that utilizes a jet of compressed air and water to deliver a controlled stream of powder through the handpiece nozzle to remove biofilm.1 Solo air polishing units are typically attached to the handpiece connection on the dental unit. The average water psi on the unit is 10-15, with an air pressure of 60 psi, allowing the unit to dispense a pressure of 58-60 psi.2 The pressure and site-specific powders enable clinicians to remove stain and biofilm in less time with minimal effort. “Air polishing can produce uniformly smooth root surfaces and remove 100% of bacteria and/or bacterial endotoxins from cementum.”~~1

Increased chairside efficiency is obtained through the implementation of an air polisher due to its ability to remove stain and biofilm without compromising the longevity of the tooth or restorations.

To properly use an air polisher supragingivally, the nozzle should be kept 3-5mm away from the surface. When polishing the anterior teeth, the proper angulation of the nozzle should be placed at 60 degrees.~~2 The proper angulation of the nozzle when polishing posterior teeth is 80 degrees and 90 degrees only when polishing the occlusal surfaces.~~2

The handpiece of the polisher should be kept in a constant circular motion to avoid gingival trauma. Utilization of a high-speed suction to reduce aerosol is advised, while using standard patient safety precautions (eye protection) and standard clinical PPE.

Most manufacturers offer solo air polishing units as well as dual units that are equipped with ultrasonic scaling technology. Additional nozzles are available to allow the air polishing unit to be used subgingivally.

It is important to ensure the correct powders are being used as recommended to avoid gingival and root trauma. There are multiple types of powder, depending on the needs of the patient. Natural glycine powder is sodium-free and used subgingivally on patients due to it’s low abrasiveness. When implementing on patients with implants, a glycine powder and titanium nozzle is recommended to avoid compromising the integrity implant.~~3 Sodium bicarbonate powder is used after scaling and is the preferred powder for stain removal, whitening, and orthodontic brackets.~~1 Calcium carbonate is sodium-free, which allows sensitive patients to be treated without discomfort and is safe to use on stained composite fillings.

Studies conducted by Muller et al, demonstrate that use of an air polisher reduced the number of 4mm pockets similar to an ultrasonic debridement with four maintenance appointments over the course of twelve months.~~1 The use of subgingival air polishing demonstrates an increased efficiency of biofilm removal of pockets greater than 5mm.~~1 “The use of glycine powder seems to have an active role on the inhibition of bacterial recolonization of implants in a short [24 hour] test period.”~~3

Increased chairside efficiency is obtained through the implementation an air polisher due to its ability to remove stain and biofilm without compromising the longevity of the tooth or restorations. Air polishing technology enables the hygienists to properly remove pathogens, without trauma (when properly used). Transforming the approaches to smooth root surfaces, air polishers are another tool for the hygienists to promote healthier gingival pockets.

References

~~1Muller N, et al. Subgingival air-polishing with erythritol during periodontal maintenance https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287198/. J Clin Periodontol. 2014 Sep; 41(9): 883–889. Published online 2014 Aug 7. doi: 10.1111/jcpe.12289.

~~2https://www.dentalacademyofce.com/courses/2423/PDF/1305cei_Barnes_RDH_final.pdf

~~3 Cochis A, et al. Effects of air polishing with glycine powder on titanium abutment surfaces. Clin Oral Implants Res. 2013 Aug;24(8):904-9. doi: 10.1111/j.1600-0501.2012.02490.x. Epub 2012 May 25.