Introduction
Periodontal diseases are usually plaque-associated inflammatory diseases and are initiated by the accumulation, organization, and maturation of biofilm on teeth surfaces. Periodontitis results from polymicrobial dysbiosis. Hence, the treatment of periodontitis can be achieved by restoring homeostasis by reducing microbial load. Recently, it was reported that treatment of periodontitis comprises of a) behavioral changes, supragingival biofilm, gingival inflammation, and risk factor control; b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; c) periodontal surgical interventions; d) supportive periodontal care. The success of periodontal treatment and maintaining of periodontal health relies on the removal of plaque and calculus from supra and subgingival areas.
Professional mechanical plaque removal (PMPR) is described as “the removal of the supragingival dental biofilm and calcified deposits (calculus) and is reported as an essential component of the treatment of plaque-induced periodontal diseases and both primary and secondary prevention of periodontitis.
The first step in periodontal therapy consists of behavioral changes in patients and motivation towards the removal of supragingival biofilm. Supragingival biofilm control is not only a keystone of both nonsurgical and surgical treatment but also maintaining periodontal health. Supragingival plaque control should be achieved by self-performed oral-hygiene measures by patients themselves, however, proper oral hygiene can not be obtained without removing pre-existing plaque, calculus, and other plaque-retaining factors professionally.
The first step of periodontal therapy as mentioned above includes PMPR. On the other hand, studies on oral hygiene measures performed by patients clearly showed that it is not sufficient to maintain periodontal health alone with the reasons of limited patient compliance, unable to use of dental floss or interdental brushes, irregular toothbrushing, etc. Hence, PMPR together with proper oral hygiene is an inevitable part of regular dental check-ups and follow-ups of periodontal treatments.
The purpose of PMPR does not perform careful root planing , but meticulous plaque and calculus removal. PMPR, supra- and sub-gingival calculus, and removal of remnants from supra- and sub-gingival areas can be achieved by hand instruments and, sonic and ultrasonic scalers, and air-polishing devices (power-driven devices) by professionals. There are numerous studies in the literature since 1950s have studied manual and sonic and/or ultrasonic scalers. Especially powdered air abrasive polishing systems have received considerable attention with various powders developed not only to disrupt the biofilm from teeth and lately implant surfaces but also for tooth polishing and stain removal. While traditional air abrasive systems were found to be more harmful on root surface, later systems have demonstrated better results without damaging the hard and soft tissues of the teeth. In individuals with gingival recession, polishing procedures affect dentine and cementum as well as enamel. In vitro studies have been conducted on extracted human and bovine teeth to determine the effects of materials used for polishing on dental tissues, but most of the studies were performed on the healthy root surface.
Air polishing devices remove dental biofilm from the tooth surface with the operating system of compressed air containing water, and abrasive particles. Air polishing devices can only remove biofilm, not calculus and other calcified or hard remnants from the tooth surface. Consequently, air polishing devices must be used along with hand instruments or power-driven devices in the treatment of periodontal diseases. Air polishing devices are safe and comfortable, require less operation time, and cause less discomfort and pain for the patient compared to traditional polishing methods, moreover, it is a less fatiguing method for the operator. Side or adverse effects of the use of air polishing devices are usually very rare which include painless gingival erosion, tooth sensitivity, abrasion of the root cementum, and subcutaneous emphysema, etc.
There are studies in the literature that compare the efficacy of air polishing devices vs ultrasonic instrumentation and air polishing devices vs hand instrumentation. The reports revealed that air polishing and hand or ultrasonic scaling are clinically efficient for interrupting and removing plaque. In addition, air polishing abrasives are also investigated for their potential harm to the hard and soft tissues in different ex vivo or in vitro settings. The surface modifications of the treated teeth and soft tissues by different air-polishing abrasives such as sodium bicarbonate, glycine, erythritol, calcium carbonate, and bioglass are evaluated not only for the specifications of the powders but also for air-polishing devices. In the literature, air polishing powders were evaluated with their grain size and shape; air polishing devices for angulation and distance of application, exposure time, and surface modification of hard tissues were evaluated with defect depth, defect volume, defect size, surface roughness, cleanliness and root substance removal the methods such as biopsy, the triplicate wax pattern of defect, average weight, electron microanalyzer, micro-CT, 3-D-measuring microscopy, SEM, confocal laser scanning microscope, light microscopy, superimposition, impressions, replicas, epoxy resin casts, and optical profilometer etc.
Since air-polishing devices are an inevitable part of the clinical periodontal practice for the treatment of periodontal diseases and maintenance, the present study was conducted to analyze the effects of different air-polishing powders on the enamel and exposed root surface.
Our hypothesis was that with erythritol air polishing, defect volumes, defect depth, and demineralization depth on enamel and exposed root surface would be smaller than those created with sodium bicarbonate and glycine powder. The second hypothesis was that defect depth, defect volume, and demineralization depth value at the maximum power setting would be higher than at medium power setting values in all groups. Therefore, the aim of this in vitro study to test these hypotheses is to evaluate the effect of an air-polishing device using three different air-polishing powders on enamel and exposed cementum surfaces in the oral cavity at two different power settings.