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The efficacy of subgingival air polishing and subgingival debridement in periodontal support therapy: a meta-analysis

Evidence-Based Dentistry volume 24, pages 142–143 (2023)Cite this article

Subjects

Abstract

Objective

To assess whether there is sufficient evidence of a difference in efficacy between subgingival air polishing (SubAP) and subgingival debridement as periodontal support treatment. The systematic review protocol was registered in the PROSPERO database under no. CRD42020213042.

Methods

A comprehensive search was conducted using eight online databases to develop straightforward clinical questions and search strategies, from their inception to 27 January 2023. The references of identified reports were also retrieved for inclusion in the analysis. The risk-of-bias of the included studies was evaluated using the Revised Cochrane Risk-of-Bias tool (RoB 2). A meta-analysis was performed on five clinical indicators using the Stata 16 software.

Results

Twelve randomized controlled trials were ultimately included, and most included studies had varying degrees of risk-of-bias. The results of the meta-analysis indicated that there was no significant difference between SubAP and subgingival scaling in terms of improving probing depth (PD), clinical attachment loss (CAL), plaque index (PLI), and bleeding on probing% (BOP%). The results of the visual analogue scale score analysis indicated that SubAP produced less discomfort than did subgingival scaling.

Discussion

SubAP can provide better treatment comfort than subgingival debridement. There was no significant difference in the efficacy of the two modalities in improving PD, CAL, and BOP% in supportive periodontal therapy.

Conclusion

Currently, evidence for assessing the difference in the efficacy of SubAP and subgingival debridement in improving the PLI is insufficient, and further high-quality clinical studies are needed.

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Fig. 1
Fig. 2: Risk of bias summary.
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References

  1. Tonetti MS, Jepsen S, Jin L, Otomo, Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. J Clin Periodontol. 2017;44:456–62.

    Article  PubMed  Google Scholar 

  2. Slots J. Periodontitis: facts, fallacies and the future. Periodontol 2000. 2017;75:7–23.

    Article  PubMed  Google Scholar 

  3. Krishna R, De Stefano JA. Ultrasonic vs. hand instrumentation in periodontal therapy: clinical outcomes. Periodontol 2000. 2016;71:113–27.

    Article  PubMed  Google Scholar 

  4. Tomasi C, Abrahamsson KH, Apatzidou D. Subgingival instrumentation. Periodontol. 2000 2023.

  5. Petersilka GJ. Subgingival air-polishing in the treatment of periodontal biofilm infections. Periodontol 2000. 2011;55:124–42.

    Article  PubMed  Google Scholar 

  6. Bozbay E, Dominici F, Gokbuget AY, Cintan S, Guida L, Aydin MS, et al. Preservation of root cementum: a comparative evaluation of power-driven versus hand instruments. Int J Dent Hyg. 2018;16:202–9.

    Article  PubMed  Google Scholar 

  7. Arzate H, Zeichner-David M, Mercado-Celis G. Cementum proteins: role in cementogenesis, biomineralization, periodontium formation and regeneration. Periodontol 2000. 2015;67:211–33.

    Article  PubMed  Google Scholar 

  8. Dos SK, Pinto SC, Pochapski MT, Wambier DS, Pilatti GL, Santos FA. Molar furcation entrance and its relation to the width of curette blades used in periodontal mechanical therapy. Int J Dent Hyg. 2009;7:263–9.

    Article  Google Scholar 

  9. Moëne R, Décaillet F, Andersen E, Mombelli A. Subgingival plaque removal using a new air-polishing device. J Periodontol. 2010;81:79–88.

    Article  PubMed  Google Scholar 

  10. Petersilka GJ, Bell M, Häberlein I, Mehl A, Hickel R, Flemmig TF. In vitro evaluation of novel low abrasive air polishing powders. J Clin Periodontol. 2003;30:9–13.

    Article  PubMed  Google Scholar 

  11. Bühler J, Amato M, Weiger R, Walter C. A systematic review on the effects of air polishing devices on oral tissues. Int J Dent Hyg. 2016;14:15–28.

    Article  PubMed  Google Scholar 

  12. Bühler J, Schmidli F, Weiger R, Walter C. Analysis of the effects of air polishing powders containing sodium bicarbonate and glycine on human teeth. Clin Oral Invest. 2015;19:877–85.

    Article  Google Scholar 

  13. Müller N, Moëne R, Cancela JA, Mombelli A. Subgingival air-polishing with erythritol during periodontal maintenance. J Clin Periodontol. 2014;41:883–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Flemmig TF, Arushanov D, Daubert D, Rothen M, Mueller G, Leroux BG. Randomized controlled trial assessing efficacy and safety of glycine powder air polishing in moderate-to-deep periodontal pockets. J Periodontol. 2012;83:444–52.

    Article  PubMed  Google Scholar 

  15. Kruse AB, Akakpo DL, Maamar R, Woelber JP, Al-Ahmad A, Vach K, et al. Trehalose powder for subgingival air-polishing during periodontal maintenance therapy: A randomized controlled trial. J Periodontol. 2019;90:263–70.

    Article  PubMed  Google Scholar 

  16. Petersilka G, Faggion CM, Stratmann U, Gerss J, Ehmke B, Haeberlein I, et al. Effect of glycine powder air-polishing on the gingiva. J Clin Periodontol. 2008;35:324–32.

    Article  PubMed  Google Scholar 

  17. Chandler J, Cumpston M, Thomas J, Higgins JPT, Deeks JJ, Clarke MJ Chapter I: Introduction. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.

  18. 刘玮健, 唐晓琳, 赵钰莹, 马春亮, 张馥, 刘丹, 于娜. 龈下喷砂与龈下超声在牙周维护期中的疗效比较. 口腔医学研究 2015; 31: 522-3.

  19. Ulvik IM, Saethre T, Bunaes DF, Lie SA, Enersen M, Leknes KN. A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy. BMC Oral Health. 2021;21:38.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 赵亦兵, 靳东思奇, 和璐, 孟焕新. 甘氨酸颗粒喷砂抛光对维护期牙周炎患者龈下微生物影响的初探. 中华口腔医学杂志 2017; 52: 410-4.

  21. Kargas K, Tsalikis L, Sakellari D, Menexes G, Konstantinidis A. Pilot study on the clinical and microbiological effect of subgingival glycine powder air polishing using a cannula-like jet. Int J Dent Hyg. 2015;13:161–9.

    Article  PubMed  Google Scholar 

  22. 袁亚娣, 贾晓威, 邵军, 徐晓芳. 龈下喷砂应用于慢性牙周炎患者维护治疗的效果评价. 广东牙病防治 2015; 23: 383-5.

  23. Hagi TT, Hofmanner P, Eick S, Donnet M, Salvi GE, Sculean A, et al. The effects of erythritol air-polishing powder on microbiologic and clinical outcomes during supportive periodontal therapy: Six-month results of a randomized controlled clinical trial. Quintessence Int. 2015;46:31–41.

    PubMed  Google Scholar 

  24. Hagi TT, Hofmanner P, Salvi GE, Ramseier CA, Sculean A. Clinical outcomes following subgingival application of a novel erythritol powder by means of air polishing in supportive periodontal therapy: a randomized, controlled clinical study. Quintessence Int. 2013;44:753–61.

    PubMed  Google Scholar 

  25. Wennström JL, Dahlén G, Ramberg P. Subgingival debridement of periodontal pockets by air polishing in comparison with ultrasonic instrumentation during maintenance therapy. J Clin Periodontol. 2011;38:820–7.

    Article  PubMed  Google Scholar 

  26. Kruse AB, Wölki BJ, Woelber JP, Frisch E, Vach K, Ratka-Krüger P. Subgingival air polishing with trehalose powder during supportive periodontal therapy: use of a conical shaped tip during a randomized clinical trial. BMC Oral Health. 2022;22:70.

  27. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.

  28. Chapple ILC, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89:S74–S84.

    Article  PubMed  Google Scholar 

  29. Mensi M, Scotti E, Sordillo A, Agosti R, Calza S. Plaque disclosing agent as a guide for professional biofilm removal: A randomized controlled clinical trial. Int J Dent Hyg. 2020;18:285–94.

    Article  PubMed  Google Scholar 

  30. Alonso V, García-Caballero L, Couto I, Diniz M, Diz P, Limeres J. Subcutaneous emphysema related to air-powder tooth polishing: a report of three cases. AUST DENT J. 2017;62:510–5.

    Article  PubMed  Google Scholar 

  31. Bruckmann C, Bruckmann L, Gahleitner A, Stavropoulos A, Bertl K. Pneumocephalus as result of nonsurgical peri-implantitis treatment with an air-polishing device for submucosal debridement—A case report. Clin Exp Dental Res. 2022;8:632–9.

    Article  Google Scholar 

  32. Boutron I, Page MJ, Higgins JPT, Altman DG, Lundh A, Hróbjartsson A Chapter 7: Considering bias and conflicts of interest among the included studies. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.

  33. Petersilka G, Koch R, Vomhof A, Joda T, Harks I, Arweiler N, et al. Retrospective analysis of the long-term effect of subgingival air polishing in supportive periodontal therapy. J Clin Periodontol. 2021;48:263–71.

    Article  PubMed  Google Scholar 

  34. Van der Weijden GAF, Dekkers GJ, Slot DE. Success of non-surgical periodontal therapy in adult periodontitis patients: A retrospective analysis. Int J Dent Hyg. 2019;17:309–17.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lorenz K, Bruhn G, Heumann C, Netuschil L, Brecx M, Hoffmann T. Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study. J Clin Periodontol. 2006;33:561–7.

    Article  PubMed  Google Scholar 

  36. Schnabl D, Goebel G, Kadletz A, Gaenzer H, Steiner R, Laimer J, et al. Cleansing efficacy of waist‐shaped inter‐dental brushes. A randomized‐controlled crossover study. J Clin Periodontol. 2020;47:30–35.

    Article  PubMed  Google Scholar 

  37. Sekino S, Ogawa T, Murakashi E, Ito H, Numabe Y Clinical and microbiological effect of frequent subgingival air polishing on periodontal conditions: a split-mouth randomized controlled trial. Odontology. 2020 2020-02-18.

  38. Jentsch H, Flechsig C, Kette B, Eick S. Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy: a randomized clinical trial. BMC Oral Health.2020;20:364.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Cosgarea R, Jepsen S, Fimmers R, Bodea A, Eick S, Sculean A. Clinical outcomes following periodontal surgery and root surface decontamination by erythritol-based air polishing. A randomized, controlled, clinical pilot study. Clin Oral Inverst. 2021;25:627–35.

    Article  Google Scholar 

  40. Mensi M, Scotti E, Sordillo A, Calza S, Guarnelli ME, Fabbri C, et al. 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. [Journal Article; Randomized Controlled Trial]. 2021;25:729–36. 2021-02-01

    PubMed  Google Scholar 

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Funding

The authors' institutions supported this study. The industry provided no funding for this study.

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Authors and Affiliations

  1. Department of Periodontal and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, 530021, P.R. China

    Zuwei Nong, Zuke Ya, Jiali Zheng, Xiangzhi Yong & Renchuan Tao

  2. Guangxi Health Commission Key Laboratory of Prevention and Treatment for Oral Infectious Diseases, Nanning, P.R. China

    Zuwei Nong, Zuke Ya, Jiali Zheng, Xiangzhi Yong & Renchuan Tao

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  1. Zuwei Nong
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Contributions

ZN developed the research protocol, conducted literature retrieval, inclusion, exclusion, and data analysis, and wrote the manuscript. ZY provided guidance for the conduct of the research and the writing of the manuscript. JZ participated in the selection of the literature. XY provided guidance for detailed research methods, and helped the literature screening and inclusion work when the opinions of the literature screeners differed. RT provided funding for this study.

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Correspondence to Zuke Ya.

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Nong, Z., Ya, Z., Zheng, J. et al. The efficacy of subgingival air polishing and subgingival debridement in periodontal support therapy: a meta-analysis. Evid Based Dent 24, 142–143 (2023). https://doi.org/10.1038/s41432-023-00910-7

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