Powders: moving it up a gear

Karin Stefanon

Air-polishing has long been an integral component of prophylaxis and expands the treatment spectrum of a comprehensive preventative–curative workflow. By achieving the perfect balance of powder, handpiece and spray head, the supra- and subgingival area can be cleaned both thoroughly and gently. To help achieve an optimum patient outcome, it is therefore advisable to use systems that belong together.
Based on the individual patient’s clinical findings, the prophylaxis team can precisely plan the powder sequence and ensure that contraindications are taken into consideration (see the Community Articles Air-polishing devices – are there any risks?; Do air-polishing devices have any contraindications?).

Although a wide range of polishing powders are available, there are basically three different grades of abrasiveness in use (depending on the degree of hardness, particle size, angle of application and contact time) involving different base substances(Deußen and Groß 2016).

On account of its particle size of 40–250 µm, the coarse-grained sodium hydrogen carbonate, often called sodium bicarbonate, is used only in the supragingival zone. The angular crystals enable the removal of stubborn accretions and stains, such as accretions from smoking, and the cleaning of cavity margins. However, because sodium hydrogen carbonate is so abrasive, its use entails diligent post-polishing to ensure smooth tooth surfaces (Deußen and Groß 2016).

Thanks to its spherical crystals that have a particle size of 45–100 µm, calcium carbonate is ideally suited to cleaning restorative materials, fissures and brackets. Even if the angle of impact is sub-optimum, the rounded particles cause very little damage to the enamel and have a very low aerosol load.

Glycine- or erythritol-based powders are the least abrasive(Strafela-Bastendorf and Bastendorf 2016).
Glycine, a hydrophilic amino acid with a maximum particle size of 63 µm, and erythritol, a water-soluble sugar alcohol with an average particle size of 14 µm (Muller et al. 2014), can be safely used in the subgingival area. Both are therefore useful in the cleaning of cementum and dentine, whereby they can be used in periodontitis treatment, to treat peri-implantitis and to clean implants. It is in these very areas that a powder must be safe to use, as well as in the surgical site. On account of their properties, glycine and erythritol are on a par in terms of being gentle on the soft tissues(Petersilka et al. 2008; Park et al. 2018).
As well as erythritol and glycine, since 2016 trehalose, another water-soluble substance with low abrasiveness (particle sizes between 25 and 35 µm), has been used in the subgingival area. In the dental practice, trehalose-based powder proved to be comparable to alternative low-abrasion powders(Kruse et al. 2019). Unlike glycine and erythritol, trehalose is a completely foreign substance for the human body (Reilly and Doering 2010; Hootman et al. 2017). It is not currently possible to say whether and how trehalose has an effect on the body.

Just as much as the choice of powder, the correct technique also has an important role to play in treatment success. Both these factors depend on the indication to be treated, and it is crucial that they correspond to the manufacturer’s instructions for use. Air polishing thus supports precise procedures in sensitive areas of the mouth, as well as the comfortable and individually tailored treatment of a wide group of patients.

Bunn C: An die Pulver. Fertig. Los – Neues Trio für die Prophylaxe; Prophylaxe Journal 5 (2019).

Reference

Deußen, Dieter E. A., and Alexander Groß. 2016. 'Air-polishing: Vom Power-cleaning zum Biofilmmanagement-Teil-1', Prophylaxe Journal, 3.

Hootman, Katie C., Jean-Pierre Trezzi, Lisa Kraemer, Lindsay S. Burwell, Xiangyi Dong, Kristin A. Guertin, Christian Jaeger, Patrick J. Stover, Karsten Hiller, and Patricia A. Cassano. 2017. 'Erythritol is a pentose-phosphate pathway metabolite and associated with adiposity gain in young adults', Proceedings of the National Academy of Sciences, 114: E4233-E40.

Kruse, A. B., D. L. Akakpo, R. Maamar, J. P. Woelber, A. Al-Ahmad, K. Vach, and P. Ratka-Krueger. 2019. 'Trehalose powder for subgingival air-polishing during periodontal maintenance therapy: A randomized controlled trial', J Periodontol, 90: 263-70.

Muller, N., R. Moene, J. A. Cancela, and A. Mombelli. 2014. 'Subgingival air-polishing with erythritol during periodontal maintenance: randomized clinical trial of twelve months', J Clin Periodontol, 41: 883-9.

Park, E. J., E. Y. Kwon, H. J. Kim, J. Y. Lee, J. Choi, and J. Y. Joo. 2018. 'Clinical and microbiological effects of the supplementary use of an erythritol powder air-polishing device in non-surgical periodontal therapy: a randomized clinical trial', J Periodontal Implant Sci, 48: 295-304.

Petersilka, G., C. M. Faggion, Jr., U. Stratmann, J. Gerss, B. Ehmke, I. Haeberlein, and T. F. Flemmig. 2008. 'Effect of glycine powder air-polishing on the gingiva', J Clin Periodontol, 35: 324-32.

Reilly, Morgann C., and Tamara L. Doering. 2010. 'Chapter 22 - Biosynthesis of fungal and yeast glycans.' in Otto Holst, Patrick J. Brennan, Mark von Itzstein and Anthony P. Moran (eds.), Microbial Glycobiology (Academic Press: San Diego).

Strafela-Bastendorf, N., and K. D. Bastendorf. 2016. 'PZR-neu gedacht', ZM, 11.