Air-polishing Device Research Articles

Abrasive Wirkung von Pulver-Wasser-Strahlgeräten auf Glattflächenversiegler

To prevent decalcification during orthodontic treatment using fixed appliances, many orthodontists use sealants to protect the enamel surface around the brackets. If the patients' oral hygiene is insufficient, air polishing devices are often used to clean the teeth. The aim of this study was to investigate the effects of air polishing on the sealant. Three sealants (Pro Seal, OrthoSolo, and Seal&Protect((R)) were used in this study. Each was applied on the surface of 30 extracted human teeth. The enamel surfaces of 10 teeth each were then air polished with the sodium-bicarbonate-based powder (Air-Flow((R))) 5 or 10 seconds, or the glycine-based powder (Clinpro Prophy) for 10 seconds. The sealant had become thinner, revealing minor defects after 5 seconds of air polishing using the sodium-bicarbonate-based powder, practically disappearing after 10 seconds. Use of the glycine-based powder allowed longer air-polishing times, but the sealant surface also showed minor defects thereafter. Reliable protection against demineralization may be seriously compromised after sealed tooth surfaces are cleaned with air-polishing devices. This finding correlates with the type of powder and air-polishing time.

Tooth polishing: Relevance in present day periodontal practice

Time has seen the emergence of more efficient and effective devices like jet abrasives. However, the role of rubber cups with prophy angles cannot be overlooked as they are still being widely used and provide an economical alternative. Owing to several shortcomings associated with the air polishing device using sodium bicarbonate (NaHCO3), trends are shifting towards the usage of low abrasive powders. Recent demonstration of Glycine Powder Air Polishing (GPAP) in removing subgingival biofilm results in less gingival erosion than hand instrumentation or NaHCO3 air-polishing. Despite the emergence of latest advances in polishing, data suggesting selective polishing of teeth is compelling.

Severe enamel abrasion due to misuse of an air polishing device

In this case report, a 28-year-old male patient who severely injured the enamel tissue of his upper incisors due to excessive self-performed air polishing has been presented. Air polishing devices are frequently used in initial or supportive periodontal therapy to remove supragingival plaque and dental stains. Enamel tissue is minimally affected by air polishing when appropriately performed by a professional. However, excessive air polishing may have detrimental effects even on the intact enamel. The aim of this case report is to present a patient who severely injured the enamel surfaces of his upper incisors due to excessive self-performed air polishing. A case of severe enamel abrasions in a 28-year-old male patient who injured the enamel surfaces of his upper incisors following several self-performed air polishing sessions has been presented. Severely abraded enamel surfaces of the upper incisors were present and during the course of therapy restored by composite restorations to establish a satisfactory clinical appearance. In clinical practice, air polishing can be performed rather safely on intact enamel and is a beneficial procedure in initial and supportive periodontal therapy when performed by a professional under recommended operating conditions. However, review of the literature reveals that air polishing may be harmful on tooth and surrounding structures unless carried out cautiously. Furthermore, excessive use of air polishing devices, especially by unauthorized personnel may be damaging and lead to severe abrasion of enamel tissue.

Effect of air‐polishing devices on the gingiva: histologic study in the Canine

The aim of this study was to evaluate histologically the immediate effect of two types of air-polishing devices (APDs) on the gingiva. The buccal gingiva in four mongrel dogs was exposed to 5, 10 and 20 s of instrumentation, applying a hand-piece type of APD (HP-APD) PROPHYflex and a stand-alone type of APD (SA-APD) Jetpolisher in a split-mouth design. Immediately after treatment, the exposed gingiva was excised by sharp dissection and fixed in 10% buffered formalin. For each specimen, 15 sections, 20 microm apart, corresponding to the central part of the treated and control untreated gingiva were cut and stained with haematoxylin and eosin. Stained sections were examined histomorphometrically for keratin width and epithelial cell layer (ECL) (prickle and basal cell layers) width. Extent of erosion was expressed as loss of keratin and ECL compared with control. Microscopic examination presented changes in keratin and ECL, including keratin detachment and disruption of the normal ECL architecture. The erosive changes in the gingiva caused by both APD, positively correlated with instrumentation time (p<0.001) and type of instrument (p=0.008). Keratin loss was significantly higher for SA APD than for the HP APD in each time interval (p=0.019). Following exposure for 5 s, both APD caused a 25% loss of the ECL. Exposure for 10 and 20 s revealed a significantly greater ECL loss caused by the SA-APD than the HP-APD (p=0.018). Exposure for 20 s was the only time interval that presented the area of total epithelium erosion with SA-APD causing significantly more (p=0.002) areas of total epithelial erosion than the HP-APD. Gingiva exposure to air-polishing slurry delivered by APD caused localized trauma because of epithelial erosive changes with severity, positively correlated with instrumentation time and design principles of the applied APD. The clinician should be aware of the potential insult of the gingiva when applying the APD and careful precautions should be taken.

Root defects following air polishing

Air-polishing devices (APDs) are highly effective in removing plaque and extrinsic staining. Their application on root surfaces, however, may result in clinically relevant substance removal, limiting the use in patients with periodontitis, where denuded root surfaces are frequently found. Therefore, the purpose of the study was to assess the influence of different working parameters on root damage and to identify those minimizing root damage. Defect depth and defect volume after instrumentation of roots with an APD (Dentsply Prophy-Jet) using conventional NaHCO3 powder at instrumentation times of 5, 10 and 20 s, combinations of low, medium and high powder and water settings, distances of 2, 4 and 6 mm, and angulations of 45 degrees and 90 degrees were quantified laseroptically. A total of 297 roots were instrumented and parameter combinations were performed in triplicate. The influence of each working parameter on substance loss was determined by multiple regression analysis. Time had the greatest influence on defect volume and depth (beta-weights 0.6 and 0.57, respectively), when compared with powder setting (beta-weights 0.49 and 0.3) and water setting (beta-weights 0.28 and 0.3). Variations in distance affected defect depth (beta-weight 0.44), but not volume (beta-weight 0.04). No major differences were found at 45 degrees and 90 degrees. Various parameter combinations led to maximal defect depths of 473.5 +/- 26.2 micro m within 20 s. Root damage varies among combinations of working parameters. Using the APD with the assessed NaHCO3 powder, all parameter combinations led to substantial root damage. Thus, APDs using NaHCO3 may not be safely utilized on exposed root surfaces.

REDUCING BACTERIAL AEROSOL CONTAMINATION WITH A CHLORHEXIDINE GLUCONATE PRE-RINSE

The authors compared the effects of chlorhexidine gluconate, an antiseptic mouthwash with essential oils and water on the bacterial aerosol contamination generated by an air polishing device. Patients rinsed with one of the three solutions before treatment. Bacterial counts collected during the treatment indicate that the chlorhexidine pretreatment rinse was significantly more effective than the other solutions in reducing bacterial aerosols.

The effect of an air polishing device on sealant bond strength

n L/ental sealants are considered an important component for the prevention of occlusal caries. Although the occlusal surface accounts for only 12% of the tooth surface, occlusal caries now accounts for 50% to 54% of dental caries.’ Considerable progress has been made in sealant technique and materials since the inception of the acid-etch technique.* Retention of the adhesive material is the major factor in assessing the success of bonding procedures and sealants.2 Retention of bonded material is enhanced if a highenergy enamel surface is created by removing oral contaminants. Current technique for removal of these contaminants uses a pumice-water slurry, rubber cup or brush in a slow-speed rotary handpiece followed by acid etching. Occlusal anatomy is such that cleaning of the deeper pits and fissures is difficult and the effect is primarily limited to the inclined planes.3-6 Even though acid etching removes additional contaminants on the surface enamel, the effect is again primarily on the inclined planes. Successful retention of the sealant and protection of the pit or fissure seems to be dependent on bonding of the resin to the inclined planes, forming a bridge of resin over the pit or fissure.’ The air polishing device has shown encouraging results in stain and debris removal from occlusal surfaces.’ A surface free of stain and debris may allow a greater degree of surface contact with an acid-etching solution in and near the fissure and possibly also between the fissure and the resin material. This may enhance sealant retention and/or decrease dependence of bonding to inclined planes. Sealant retention potential in laboratory studies is assessed by using tensile bond strength tests and evaluation of tag formation. Studies by Brockmann and Scott* substituting air polishing for traditional pumice-water slurry cleaning showed higher bond strengths and greater numbers of tag formation although there was not a statistically significant difference between the means of the two groups. The studies did not include testing tensile bond strength after periods of water immersion. Additional testing after such immersion is a logical step