Do You Know About Air-Flow Perio?

by Karen Davis, RDH, BSDH

Consider reading: The absence of periodontal inflammation
http://www.rdhmag.com/articles/print/volume-32/issue-11/columns/the-absence-of-inflamation.html

Consider reading: America's sweet tooth obsession and its impact on our health
http://www.dentistryiq.com/articles/2012/09/americas-sweet-tooth-obsession-and-its-impact-on-our-health.html

Consider reading: Tobacco Cessation With A Twist
http://www.rdhmag.com/articles/print/volume-32/issue-7/columns/perio-team/tobacco-cessation-with-a-twist.html

Having treated patients for over 30 years, I recall technological advances that have been remarkable: power toothbrushes, intraoral cameras, automated probes, salivary diagnostics, caries and oral cancer detection devices, lasers, loupes, and power-driven technologies – but in all of my career I don’t know that I have been as surprised by the clinical results of a technology as much as I have been with the Air-Flow Perio by EMS.

Have you seen it or read about it? If you were practicing in Europe today, this would likely be part of your standard armamentarium. In a nutshell, this is a device that destroys biofilm in a periodontal pocket in about five seconds. Does that sound too good to be true? Well, being the skeptic that I am, I put this technology to the test. Seeing diseased, hemorrhaging, and biofilm-infested pockets be rendered “squeaky clean” within a few seconds of this flexible tip being placed into the pocket and treated with a low-abrasive glycine powder is rather amazing. Figure 1 shows the Air-Flow Perio tip design, and Figure 2 shows the EMS Air-Flow Master Piezon unit that combines piezo power-driven technology, and Air-Flow air-polishing technology using sodium bicarbonate, and Air-Flow Perio technology using glycine powder. The ability to have all three technologies wrapped into a single unit is certainly efficient. The more you understand the clinical benefits of subgingival debridement with glycine powder, the more your paradigm may shift regarding how you treat periodontal pockets.

Safety of Glycine Powder

Several safety studies have evaluated the effects of subgingival glycine powder on the epithelium, tooth surfaces, and implants. A study from the Journal of Clinical Periodontology in 2008 compared the safety and efficacy of glycine powder with sodium bicarbonate powder and hand instrumentation using histological analysis on the gingival epithelium in vivo and concluded that glycine powder air-polishing caused less gingival erosion than both hand instrumentation and sodium bicarbonate air polishing.¹ Other studies concur in the safety of air-polishing with glycine powder on tooth surfaces,2 nanocomposite restorative materials,3 implants,4 and abutment surfaces.⁵

Biofilm Removal

Ramfjord and others were some of the first researchers to conclude that even if patients did not maintain perfect plaque control, when they participated in supportive periodontal therapy every three months for professional biofilm removal, they could be stabilized for years without disease progression.⁶ Every practicing dental hygienist knows how unequivocally critical plaque biofilm removal is in order to establish and maintain periodontal health, yet the greater the pocket depths, the more challenging that becomes. What is the most effective method to dismantle subgingival biofilm? Is it the use of lasers, power-driven technology, hand instruments, or all of the above? A 2012 study published in the Journal of Periodontology evaluated chronic periodontitis patients who showed bacterial infections with P. gingivalis and T. forsythia, and randomly assigned them to receive supra- and subgingival air-polishing with glycine powder, followed by calculus removal with hand curettes, or scaling and root planing (SRP) with hand curettes followed by coronal polishing. It’s interesting that the patients receiving subgingival air-polishing resulted in significantly lower bacterial counts, and P. gingivalis remained significantly lower for the glycine powder group compared to standard SRP even at 90 days post-therapy.⁷ A different study compared ultrasonic instrumentation during periodontal maintenance to subgingival air-polishing with glycine powder and concluded that there were no clinical or microbiological differences between subgingival air-polishing with glycine powder and ultrasonic debridement, but perceived discomfort was lower for air polishing.⁸

Implant Care and Peri-Implantitis

Subgingival glycine powder air-polishing has been shown to be clinically effective in treatment of peri-implantitis as well as adjunctive local delivery of antibiotics and Er:YAG laser treatments, with greater reduction in bleeding on probing with (glycine powder) air polishing compared to subgingival debridement using curettes with adjunctive chlorhexidine.⁵ Even in cases of severe peri-implantitis, at six months posttherapy, patients showed similar clinical improvements when treated with either the Air-Flow Perio or the Er:YAG laser.9

While additional studies should be conducted to reproduce clinical results reported here, I can say from personal experience with use of the Air-Flow Perio that these types of clinical results coincide with what I am witnessing in individual patients. Hopefully, clinicians in the U.S. will adopt more widespread use of the Air-Flow Perio and begin to obliterate tenacious subgingival biofilm safely and efficiently with this novel technique. You may learn more about this technology at www.ems-company.com. RDH

References

1. Petersilka GJ, Faggion Jr. CM, Statmann U, Gerss J, Ehmke B, Haeberlein I, Flemmig TF. Effect of glycine powder air-polishing on gingiva. J Clin Periodontol. 2008; 35(4):324-332.
2. Flemmig TF, Hetzel M, Topoll H, Gerss J, Haeberlein I, Petersilka G. Subgingival debridement efficacy of glycine powder air polishing. J Periodontol. 2007; 78(6):1002-1010.
3. Giacomelli L, Salerno M, Derchi G, Genovesi A, Paganin PP, Covani U. Effect of air polishing with glycine and bicarbonate powders on a nanocomposite used in dental restorations: an in vitro study. Int J Periodontics Restorative Dent. 2011; 31(5):51-56.
4. Schwarz F, Ferrari D, Popovski K, Hartig B, Becker J. Influence of different air-abrasive powders on cell viability at biologically contaminated titanium dental implant surfaces. J Biomed Mater Res B Appl Biomater. 2009; 88(1):83-91.
5. Muthukuru M, Zainvi A, Esplugues EO, Flemmig TF. Non-surgical therapy for the management of peri-implantitis: a systematic review. Clin Oral Implants Res. 2012; 23(suppl)6:77-83.
6. Flezar TJ, Knowles JW, Morrison EC, Burgett FG, Nissle RR, Ramfjord SP. Tooth mobility and periodontal therapy. J Clin Periodontol. 1980; 7:495-505.
7. Flemmig TF, Arushanov D, Daubert D, Rothen M, Mueller G, Lerouz BG. Randomized controlled trial assessing efficacy and safety of glycine powder air polishing in moderate-to-deep periodontal pockets. J Periodontol. 2012; 83(4):444-452.
8. Wennstrom JL, Dahlen G, Ramberg P. Subgingival debridement of periodontal pockets by air polishing in comparison with ultrasonic instrumentation during maintenance therapy. J Clin Periodontol. 2011; 38(9):820-827.
9. Renvert S, Lindahl C, Roos-Jansaker AM, Persson GR. Treatment of peri-implantitis using an Er:YAG laser or an air-abrasive device: a randomized clinical trial. J Clin Periodontol. 2011; 38:65-73.

KAREN DAVIS, RDH, BSDH, is the founder of Cutting Edge Concepts, an international continuing education company, and practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corp. and serves on the review board for Dental-antioxidants.com. She can be reached at [email protected].