Air polishing as an adjunct to ultrasound?

PD Dr. Kristina Bertl, PhD MSc MBA

According to the recently published S3 guidelines about treating patients with stage I–III periodontitis (Sanz 2020), the current evidence-based recommendation is to perform subgingival debridement as part of non-surgical periodontal treatment with hand instruments and/or (ultra)sound devices. But of course, the search continues to find options that will further improve the outcome of non-surgical periodontal treatment.

This was the case in a recently published study from Italy (Mensi 2021) in which the authors tested an interesting approach: can the outcome of non-surgical periodontal treatment using ultrasound be improved by adjunctive subgingival cleaning using an air-polishing device?

To answer this question, the study enrolled 40 patients with stage III–IV periodontitis, who were divided into two groups:

The outcome of treatment was evaluated 3 months later. The main parameter was the attainment of a pocket probing depth of ≤ 4 mm with no bleeding on probing at sites that had exhibited pocket probing depths of ≥ 5 to 9 mm at the start of treatment. The proportion of sites that exhibited a pocket probing depth of ≤ 4 mm with no bleeding on probing after 3 months did not differ significantly between the test and control groups (control group: 44.7%, test group: 47.9%). Similarly, the proportion of sites that achieved at least a pocket probing depth of ≤ 4 mm, regardless of bleeding on probing, did not differ significantly between the test and control groups (control group: 77.6%, test group: 80.0%). In general, a pocket probing depth of ≤ 4 mm with no bleeding on probing was less likely to be achieved in teeth with deep pocket probing depths (7–9 mm) at the start of the study, in teeth with plaque at the end of the study, and in teeth with more than one root.

The authors therefore concluded – fully in accordance with the S3 guidelines – that subgingival debridement with ultrasound should still be regarded as the ‘gold standard’, and that a clinically relevant improvement in outcome could not be achieved by additional subgingival cleaning using an air-polishing device.

Reference

Mensi M, Scotti E, Sordillo A, Calza S, Guarnelli ME, Fabbri C, Farina R, Trombelli L. Efficacy of the additional use of subgingival air polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial. Clin Oral Investig. 2021 Feb;25(2):729-736.
Sanz M, Herrera D, Kebschull M, et al; On behalf of the EFP Workshop Participants and Methodological Consultants. Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47:4–60.