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FI Mod. 27 Air Polishing for Biofilm Management and Stain Removal…
FI Mod. 27 Air Polishing for Biofilm Management and Stain Removal
Nonsurgical periodontal therapy
term used to describe the many nonsurgical steps used to eliminate inflammation in the periodontium of a patient with periodontitis in an attempt to return the periodontium to a healthy state
Goal of nonsurgical therapy-
control the bacterial challenge to the patient
minimize the impact of systemic risk factors, to eliminate or control local environmental risk factors
stabilize attachment level
formation of plaque biofilm communities on tooth surfaces is the primary cause of gingivitis and periodontitis
biofilm are resistant to topical chemical control, therefore, constant mechanical removal of plaque biofilm is an essential component of successful nonsurgical perio therapy
the thoroughness of biofilm removal can determine the overall success of disease prevention or nonsurgical periodontal therapy in most patients
Air Polishing Technique
uses a combination of an abrasive powder with water and compressed air delivered to the tooth surface through an air polishing nozzle
sub-gingival air polishing for the removal of biofilm from root surfaces is a relatively new technology with clinical research supporting its safety and efficacy
shallow subgingival biofilm removal is accomplished using a Standard Metal Nozzle and a glycine based powder
deep subgingigival biofilm removal is accomplished with a flexible plastic tip
in the US, the FDA has approved the plastic perio tip for perio pockets up to 5 mm in depth
Conventional Air polishing
most common powder used is sodium bicarbonate powder
intended for supragingival use only
Subgingival air polishing
uses a specifically designed low-abrasive powder at a limited pressure
glycine based powder is most commonly used for subgingival air polishing
Sodium bicarbonate-based powders
have large particle size and are recommended for stain removal from enamel surfaces
salty tasting ans stinging sensation that some patients find unpleasant
not recommended for use on root surfaces
not recommended for patients with exposed root surfaces
Glycine based powders
has very fine, round, soft particles, it is an excellent choice for subgingival biofilm removal
gentle on the soft tissues of the oral cavity and the subgingival epithelium
as gentle as air-water syringe spray on the tissues
approximately 80% less abrasive than sodium bicarbonate
Iantrogenic Facial Emphysema
rare condition that results from the accidental introduction and collection of air in the soft tissues of teh face from the use of pressurized air in dental procedures
may be misdiagnosed as an allergic reaction by emergency healtcare providers
Symptoms:
associated with dental treatement- facial swelling, a crackling feeling of the face and neck area, tenderness, and pain
Causes:
after use of high-speed dental handpieces, and air /syringes, and even after taking impressions
Selection of Correct Powder and Powder Chamber
Supragingival treatment
stain removal
Subgingival treatment
biofilm control
Powder exchange or Refill During Treatment
a common treatment sequence is:
the use of sodium bicarbonate powder for coronal stain removal
followed by glycine powder for subgingival biofilm removal
Aerosol: a small droplet usually 5 micrometer or less in diameter, which can remain suspended in air for some time
patient preparation: a preprocedural rinse for the patient is recommended to reduce the bacterial load in aerosols generated and released into the surrounding
PPE
clinician should wear gown with high neck, long sleeves, mask, protective eye wear, gloves.
mask with a high bacterial filtration efficiency is recommended for all powdered instrumentation procedures
effectively filters out 98% of particles that are three microns or larger in size.
subgingival air polishing is much more efficient in removing subgingival biofilm than a curet or ultrasonic tip
Correct Technique for Sodium Bicarbonate Polishing
nozzle should be held 3-5mm away from tooth surface
note that the sodium bicarbonate powder spray is directed away from the gingiva
for anterior teeth, angle between the nozzle and the tooth can be varied between 30-60 degrees
Stroke:
make constant circular pattern over the coronal tooth surface for 1-10 secs
positioning of the nozzle and high volume evacuator tip for the maxillary teeth
be sure not to direct the sodium bicarbonate powder spray toward restorations, crowns, or bridgework, as this could damage them
Standard metal nozzle
used with glycine-based powder to achieve up to 4mm of biofilm removal in sulci or shallow pockets
Subgingival Polishing using a Flexible Plastic Tip & Glycine-Based Powder
uniquely designed to protect the soft tissue attachment at the base of the sulcus or periodontal pocket
Special precautions should be observed when working in a periodontal pocket that is greater than 4mm in depth
clinician should evaluate amount of alveolar bone support remaining around the tooth
plastic subgingival tip is not recommended for use on a tooth that has 3mm or less of supporting alveolar bone
*there is a risk of soft tissue emphysema if a tooth site has 3mm or less of supporting bone
Post treatment precautions and measures
allow the patient to rinse mouth with water after treatment
it is beneficial to apply colorless neutral sodium fluoride treatment to the teeth
Direct patient to avoid smoking or consumption or highly colored food or drinks for at least 3 hours