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.